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Andy Roark DVM MS

Blackmarket FIP Cure Update

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Dr. Julie Levy returns to share an update on the black market FIP cure from one of the most popular episodes of 2022. In this episode of the Cone of Shame Podcast, Dr. Andy Roark and Dr. Julie Levy discuss recent updates on drug approvals for remdesivir as a treatment for FIP. They explore how clients can save the lives of their FIP-diagnosed cats, what veterinarians can do to monitor success, and which resources are available to help in the battle against FIP. Tune in for essential insights and practical advice on managing this challenging condition.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

FIP Warriors: https://fipwarriors.com/

Clinicians Brief Article: https://www.cliniciansbrief.com/article/feline-infectious-peritonitis-treatment-outcomes

Uncharted’s Conflict Management at HiVE: https://unchartedvet.com/conflict-management-training-navc-hive/

Black Market FIP Cure Podcast Original: https://drandyroark.com/cure-for-fip/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Julie Levy is the Fran Marino Distinguished Professor of Shelter Medicine Education at the University of Florida, where she focuses on the health and welfare of animals in shelters, feline infectious diseases, and humane alternatives for cat population control. She founded Operation Catnip, a nonprofit university-based community cat trap-neuter-return program that has spayed, neutered, and vaccinated more than 80,000 cats in Gainesville since 1998. In 2008, she joined Dr. Cynda Crawford to found Maddie’s Shelter Medicine Program at the College of Veterinary Medicine, an educational and discovery initiative with a global impact on the care of homeless animals. In 2014, she joined Dr. Kate Hurley to launch the Million Cat Challenge, a shelter-based campaign that saved more than 4.5 million cats in shelters across North America. In 2022, she helped launch Maddie’s Million Pet Challenge to create transformative “communities of practice” that deliver access to care through humane, community-centric programming—inside and outside of the shelter—to achieve the right outcome for every pet., Dr. Andy Roark is a practicing veterinarian, international speaker, author, and media personality. He is the founder of the Uncharted Veterinary Conference and DrAndyRoark.com. He has been an award-winning columnist for DVM360 and his popular Facebook page, website, and YouTube show reach millions of people every month.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am back with one of my veterinary idols, dr. Julie Levy. She means the world to me. I just, she’s so great for cats. She is so great for our profession. I just I, I’m always so happy when I get to talk to her.

 She was on about a year, year and a half ago, and she dropped the most popular Cone of Shame episode we’ve ever had. I mean, it was tens of thousands of plays. And it was all about a black market cure for FIP. And it’s been at least a year, year and a half since since we did that. And I want to get her back on and sort of talk about where we are today.

This is a great refresher on treatment of FIP. It’s also an interesting conversation about sort of where we are with access to the drugs and also what veterinarians are able to do and not do. And it turns out there’s a lot of things we’re really not all, we’re really not able to do but how do we support pet owners to get their cats taken care of and save lives?

That’s what we get into a really fun episode guys. Let’s get into this.

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. Julie Levy. Thank you for being here.

Dr. Julie Levy: Thank you, Andy. It’s so good to see you again.

Dr. Andy Roark: You, as well. So, you, it’s an absolute joy to have you on here for a couple of reasons. The first is you were the guest on the most popular podcast I’ve ever been a part of. We did a Black Market Cure for FIP. It’s been about a year, a year and a half, and it has outperformed anything else that I’ve ever done,

that I’ve ever made. It has been wildly popular. And so I’m, I’m really glad to have you back to talk a bit more about that. But, but on a personal note, you’re someone who I’ve, I’ve admired since my first days in veterinary school. For those who don’t know you, you are, I have to catch my breath the Fran Marino Distinguished Professor Shelter Medicine Education at the University of Florida.

You helped you, you started the shelter medicine program at University of Florida. You are the founder of Operation Catnip at the University of which I just, I cannot overstate how important that was to me. I graduated from veterinary school with so much more confidence in surgery than so many other veterinary school graduates because I got the opportunity to go on the weekends and and do spays and neuters and even just vaccinations.

That the practicing and the doing it. And so it’s a wonderful service. You guys have, I think spayed and neutered over 80,000 cats… 

Dr. Julie Levy: That’s right. 

Dr. Andy Roark: In and around Gainesville. It’s incredible. And, and it was so much hands on education and training for me. It just, it meant so much for my confidence and just, it was. It was something I always just really appreciated.

I just wanted to say that to you. How, what an impact it had for me personally. So thank, thank you for that.

Dr. Julie Levy: Thank you for saying that, Andy. And, and they still to this day are running Operation Catnip, spaying and neutering now about 9, 000 cats a year. And most of those are done by our veterinary students. So the UF students really have an opportunity for outstanding surgical experience.

Dr. Andy Roark: It was, it was a huge deal for me personally. And so I just, I love that you guys are still doing that. I wanted to, to have you back on just because of the reasons I said at the beginning. You came back into my orbit when I was talking to a veterinary student who was like, yeah, there’s this cure for FIP and you’re supposed to send pet owners to this Facebook group.

And that’s where I was like, that’s not right. And I talked to you and it totally was right. I was like, oh my goodness. And so we’ve gotten, I’ve gotten so many questions about this sort of episode and things like that. So I wanted to sort of circle back around. Let’s, let’s touch again on so treatment for FIP and kind of where we are and then I want to get into the legality of this and then finally into the role of the veterinary professional in helping make this care possible.

So if you don’t mind, give me, give me a high level overview of where are we with treatment of feline infectious peritonitis.

Dr. Julie Levy: Well, first off, who of us ever thought we could say cure and FIP in the same sentence? And I’m as shocked as anybody, and I’m always very skeptical of miracle cures that come along. We see them all the time. They never pan out. This one really did. Professor of mine at UC Davis Dr. Niels Peterson discovered antiviral drugs that cure FIP in most cats that are treated.

And it turns out that one of those drugs is Revdesivir, which later became the primary drug used for COVID, and then its related compound, which is known by an abbreviation called GS. Now, those drugs are bound up they’re not approved by FDA. In this country, well, Remdesivir now is approved for use in people, which means it’s also approved for use in animals.

And then GS, which is more popular and more affordable, is not approved in the U. S. and it is bound up by the intellectual property laws by patents. So when word got out that this, these compounds, especially GS, were available and were, effective in cats, cat owners themselves were the ones that really went out and found out where they could get it out of desperation, because like all of us, we’ve diagnosed FIP and very sadly told people that basically they could watch their kitten die.

And so these folks found out that they could go to Chinese. Chemical companies and they could order chemical grade G.S. and that was shipped illegally to the U. S. And little batches of unlabeled vials. And people started injecting it into their cats and, and saving their cats. 

So these cat owners found out that they’re, they could effectively treat cats and they started a group called FIP Warriors. And this is a Facebook group that anybody can go on and give information about their cat. They would ask for the medical records and the lab work.

And then they would give advice on how to treat the cat and where to get the drug. And this was all very kind of confusing and undercover for a while when it first came out. And then now there’s multiple papers that are published in the scientific literature about how to treat cats and how people are getting these drugs still not approved in the U. S. But still very effective and tens of thousands of cats have been treated internationally with about an 80 percent survival rate, a parent cure for these, these kitties that have what was used to be a fatal disease. And so now it’s very well organized. They have a lot of information and yet it’s an unapproved drug.

So veterinarians want to know, kind of, where they can play. In this, they don’t want to certainly should not order the drug themselves, prescribe the drug, or dispense the drug. And so the role that we found that most veterinarians are kind of comfortable with is making a diagnosis, teaching owners how to give injections and give pills.

And running lab work and giving supportive care, but then referring them to the Facebook page, which is the surprising thing that we never thought we would do as veterinarians is saying, go to FIP warriors, and they will give you an action plan for your cat. And then they will tell that person where they can meet someone to get some drug.

And this is the really shady part. Usually it’s like the other parts are shady at all, but this part’s like the most shady part, which is they usually say, you know, let’s meet at a closed gas station and somebody will meet you and give you unmarked files and you will get the money and you should go and check that in your cat.

And everybody I talk to and refer to the Facebook warriors page says, that’s exactly what happened. We met in an alley at night and they gave me drugs. And now my cat is alive.

Dr. Andy Roark: They gave me some Chinese pharmaceuticals and I paid in cash. And that’s what happens. And I just, I can’t believe we’re a part of this interaction in any way, shape or form. It’s, it’s amazing to me. Have it doesn’t sound like there’s been really any sort of progress made in increasing access or availability since you and I talked a year, year and a half ago. Is that true?

Dr. Julie Levy: It’s on a practical basis. That’s true. Legally. Remdesivir became fully approved for use in people, which then allows veterinarians to use it off label in cats. However, it’s not been available through veterinary distributors. Some folks have been able to get it from human hospitals. So a veterinarian can call up their human hospital and see if they will share some Remdesivir.

for a veterinary patient. We do that for all kinds of other drugs that we need occasionally that aren’t stocked by, by veterinary pharmacies. So, that is something that veterinarians can do and that would be totally legal. It’s just been a challenge to get access to the drug. Also, it’s several times more expensive. So we’re talking Many thousands of dollars rather than a few thousand dollars to treat a cat.

Dr. Andy Roark: Talk, talk to me a little bit about, so it’s, it’s really been fascinating. So there was an article in Clinician’s Brief that came out and they were talking about remdesivir and they were, they were quoting doses of, you know, 10 per kg. And so, but it was, it’s all this really weird. The language around all of this is really strange, and so shout out to Clinician’s Brief for sort of covering this and talking about it, which I appreciate, but it’s all still kind of strange.

Can you talk to me a little bit about the number jumbles that are out there? So it seems to me, when we look at remdesivir, we start to talk about the GS. There’s GS441524, which seems to be the, the go to treatment. But then if you get in there and people start, I don’t know if they’re throwing out on slang, but there’s somebody’s like talking about GS441 is that different?

Is that the same? And then there’s GC376, which is another thing. And so can you help me at least make some sense of this so that I. I don’t feel, I guess either foolish when I talk about it or when a, when a pet owner comes back with a very logical question of I’m seeing these other things, I have some bearing of even what that sort of means. Can you help me get my feet under me here?

Dr. Julie Levy: Absolutely, it is confusing. So remdesivir is the licensed drug. There is a pro drug of remdesivir called GS 441 blah blah blah and that is actually more effective we think than remdesivir is for FIP. And so GS and GS441 and GS, the long 441, are all the same thing. It’s just abbreviated as GS. That’s the most common drug that people are getting, not licensed.

Now GC is different. That is a drug that Dr. Peterson at UCD also discovered works against FIP. And that one is being moved through the FDA approval process by a drug company. That is developing it, and so eventually, maybe within a year or two, that drug will be legally available to veterinarians in the U.S.

Dr. Andy Roark: Okay, so that, that does, that does help me. 

Dr. Andy Roark: Hey guys, I just have to jump in with incredible news. I will be traveling with the Uncharted Veterinary Conference team. That includes Stephanie Goss and Maria Pirita we are going to Minneapolis for the NAVC HiVE conference that is there. This is on June 15th and 16th guys. We are doing a one day Uncharted conflict management training program. 

That’s right and it is included with the cost of HiVE. All you have to do is register for the HiVE conference that’s $99 for two days, one day, you can spend it with us, bring your team, send multiple people from your practice, put them together. We’ll put them at round tables. We will have them working together, talking about conflict management. 

We’re going to take them through a whole day. This is not a series of lectures. It’s not, they’re going to go to one and they’re going to do something else. Nope. Check the box register for the Uncharted event at HiVE. And you will spend the day with us. And I guess you’re never going to see an Uncharted event that is a day long. 

That is $99. Again, like this is the best price you will ever see on conflict management. So anyway, if you are anywhere near Minneapolis, June 15th and 16th, Come to the HiVE event it’s $99 and you get a day with Uncharted. If you register for it and the other day, you can use it HiVE and get their amazing CE for technicians and managers. Anyway I’ll put links in the show notes. 

You should learn more. I’m serious. If you were within hours of HiVE, there was never going to be a chance for you to sign up multiple team members come together. And do conflict management training as a group. This is a phenomenal opportunity, please don’t miss it. If you’re able to make it, it’s going to be great. 

Let’s get back into this episode. We’ve talked a little bit about, about what the veterinarian’s role is. It seems like it’s pretty darn hands off. There’s, there’s just not, there’s just not a lot to do here. We, you know, when I’m, when I’m checking blood work, things like that, Julie can you give me any guidance on kind of what I’m looking for here as opposed to just saying, here, take this blood work back to a Facebook like feels terrible.

Dr. Julie Levy: That feels weird. 

Dr. Andy Roark: Got like, yeah, it feels bad. Get, can, can you give me at least some, some buoys, you know, in the passageway that I can kind of mark where I’m going.

Dr. Julie Levy: So, it’s really interesting, because this group is very data driven. So they’ve collected tens of thousands of sets of data, and they’ve followed the cats over time, and notice which ones have relapses or don’t respond. What kinds of FIP need higher doses of drug. So kind of from a baseline, there’s a regular FIP, wet FIP, it’s probably the best one.

So that’s going to start off at about 10 milligrams per kilogram. And then higher doses right from the start for cats that have FeLV or cats that have neurologic or ocular sites because those are a little harder to get drugs into those sites, the CNS and the eyes. So right from the start they get a higher dose.

They also will start right from the start on injectable because that’s going to be more effective and better bioavailability. Then often, they will switch to pills when cats are more stable and they’re recovering because that’s a little less stress on the cat to get the pills rather than the injections, which are pretty stingy.

Now, the blood work that you’re going to follow, there’s a few things that really do usually start out abnormal and then normalize if the cat is responding. The most important one is the albumin to globulin ratio. Most cats with FIP, but not all, will have a very low albumin to globulin ratio. And as they’re responding to treatment, you just see that go back to normal.

Also, they often have a high white blood cell count, high neutrophil count low lymphocyte count, and they’re often anemic as well. And all of those in the responding cats just like track towards normal and they don’t stop treatment until they are solidly normal. So they might recommend extending treatment if the lab values are still abnormal.

Dr. Andy Roark: What, what’s the general, I know this is going to vary with, with the type of FIP and, and the specific kitten, what are we talking about from a timeline here? I mean, I know a lot of the research that was done we’re looking at, you know, six months out and things like that. If I want to try to set some expectations or even just kind of understand what sort of a process the pet owner is getting into, what is it?

What is a reasonable sort of ballpark timeline?

Dr. Julie Levy: So the current therapy is 84 days of daily medication, followed by 84 days of observation. And there’s some blood work that’s been, that is done during the observation period so that you can tell if a cat is falling back and needs to be restarted on medication. What we’ve learned over time is that the vast majority of cats that survive a week are going to live.

And so, and, and even really four days, if they’re still alive within four days of treatment, they often, most of them are going to go on and live. So, if you are on the fence or a client is on the fence about, is it worth it? How will I know if my cat will respond? That very early response is very predictive of how the cats would do.

So I would recommend for most people, like, give it a shot, give it a week, and see how the cat responds. And usually it’s dramatic. Like, it kind of defies logic that these cats can go from death’s door sometimes, unable to stand, unable to eat, and within a couple days, they’re already markedly improved.

Dr. Andy Roark: That’s phenomenal. Thank you so much, Julie, for being here and for talking through this stuff with me. I, I always love it. You are such a wealth of information. I just really appreciate your time. If there are people who want to learn more, are there, are there resources out there that you really recommend, places that you like?

Dr. Julie Levy: I, I, you know, I hate to be the person that says, go to Facebook, but FIP Warriors is an incredible source of information for cat owners to go to. Now there’s also a FIP Warriors for Veterinarians group and I like that one because that is only veterinarians talking to each other and reviewing lab work and and helping each other kind of navigate the guardrails of where they can practice.

So I recommend that one. We also have on our shelter medicine website, we have a whole section on research that we’ve done and clinical trials that are going on and there’s some also some links to websites that are specifically focused on the veterinary aspect of treating this for veterinarians.

Dr. Andy Roark: That sounds great. I’ll put links to all that down in the show notes and get everybody set up. Julie, thank you so much for all you do for cats. Thank you so much for what you do for vet students like myself back in the day. You are just a joy. Guys, thanks for listening to everybody. Take care of yourselves, gang.

Dr. Julie Levy: Thanks, Andy.

And that’s it. That’s what I got guys I hope you enjoyed it. I hope you got something out of it. If you did you share with your friends I I really I want I want to save cat lives and we do that with education. So feel free to pass this episode on to other people and just make sure that everybody’s kind of on the same page.

This is a really weird situation in my opinion, where the veterinarian’s hands are really tied. It’s still, it’s always going to feel really strange to me sending people to a Facebook group to get help, but it’s, it’s a hard pill for me to swallow, but, but I think that that’s where we are right now.

And so anyway make sure you help me spread the word. All right, guys, take care of yourselves. I’ll talk to you later. Bye. 

The Work of The Veterinarian

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When I entered veterinary school, I thought I’d graduate into a position of decisive clarity. After all, knowledge was clearly a ladder and as each class stacked on top of the last, I felt I must be getting closer and closer to having all the information necessary to be a doctor who knew what to do. Surely the accumulation of almost 20 years of (mostly) correct answers would grant me a sense of both control and certainty as I looked into the sad eyes of the ill patients set before me. At some point, all of this was going to come together and give me a sense of confidence about how to practice medicine… right?

Well… that didn’t happen.

Friends, I’d like to share with you (and especially those of you who are just graduating from veterinary school and entering the workforce) one of the great secrets of practice. Here it is:

Neither graduation from veterinary school, internships, residencies, nor decades of practice will grant us the control or certainty most of us thought we’d have when we became doctors. Instead, and quite conversely, our training has granted us the opportunity and responsibility of being the person who gets to make decisions when there is little or no certainty.

That’s it.

Veterinary school does not lead us to the job of continually selecting what is good for our patients and what is bad for them. It instead transforms us into people who are educated and respected enough to carry the burden of frequently choosing between two or more objectively bad options. Our DVM degrees don’t give us clarity. They qualify us to lead others into and through the humbling fog of uncertainty that surrounds emotion, resource management, illness, and death.

I don’t tell you this to deflate anyone’s spirits. I’m also not saying it to take anything away from our wonderful profession. I simply think that we do young doctors a disservice when we don’t tell them clearly what the job they are training for entails. We set them up to believe that decisions should be much easier than they actually are, and that can make them feel like they are failing when they are, in fact, just searching like the rest of us.

The reality of what we do, the navigation of uncertainty, shouldn’t be surprising to us. This challenge is what waits for all who climb to the top of their chosen vocations. To be truly great at something is to have risen past the easy answers so that people come to you with problems others are unable to solve. As Dean Acheson, secretary of state for Harry Truman, once said: “At the top, there are no easy choices. All are between evils, the consequences of which are hard to judge.”

The same is true for facing down illness. Our training often does not light the correct path for us, our clients, and our patients. It simply makes us the best people available to hold the torch and lead the search in the darkness. 

If you find yourself searching and wonder why you never seem to get the easy cases, please know that you are not doing anything wrong. You are simply living the life of a healer in the real world. You are shouldering the responsibility that our patients, clients, and society need someone to carry. Yes, the burden feels heavy sometimes, but it is a responsibility we should be proud of. Anyone can google a “right answer.” It takes a special kind of person to make decisions when there IS no right answer. That is the work of the veterinarian.

Return of the Independent Practice Owners

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Dr. Matt Salois joins the podcast to discuss the currently perfect conditions for an influx of new independent practice owners. In this episode of the Cone of Shame Podcast, he and Dr. Andy Roark explore how the slowdown in corporate consolidation combined with the availability of technology and services could spark a renaissance in veterinary practice ownership. They also touch on the future of independent practice ownership and the changing demographics within the field. Tune in to understand the evolving landscape and what it means for aspiring veterinary practice owners.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Matt Salois LinkedIn: https://www.linkedin.com/in/msalois/

VMG: https://www.myvmg.com/

Team Training Kit: https://drandyroark.com/product/team-training-bundle/

Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: https://drandyroark.com/store/

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Matthew Salois, PhD is currently the President of the Veterinary Management Groups (VMG), where he is responsible for enhancing the economic and cultural success of more than 2,000 veterinary member practices. Most recently, Matt was the chief economist and head of the veterinary economics division at the AVMA between 2018 and 2022, where he applied his skills in economics, business, and communication to support the daily lives of veterinarians. From 2014 to 2018, he served as senior director of global scientific affairs and policy at Elanco Animal Health. Matt is also an adjunct professor of applied economics at the University of Florida, where he previously taught and advised graduate and undergraduate students. He earned his Ph.D. in Applied Economics from the University of Florida and holds an M.A. in Economics and a B.S. in Health Services Administration from the University of Central Florida.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a fun business nerdy episode today. It’s me and Dr. Matt Salois. Matt is the president of VMG, the Veterinary Management Group, and we are talking about the possible resurgence of the independent practice owner.

We went through a period where corporate consolidation was happening and we were seeing corporate groups buying and buying and buying practices. And that has slowed dramatically. Are we seeing the independent owners coming back now? Has the landscape changed enough that it is favorable?

Are there people who want to own their practices independently? Matt says there are, and I want to believe him. And so we get into that and kind of what the demographics look like for practice going forward. We talk about, we talk about what practice might look like in the future. He talks about three big drivers that are sort of driving an independent practice resurgence.

And then we talk a little bit about the future and what the next five years might look like. And so anyway, it’s a good, honest conversation with some good stuff and maybe some stuff that’ll keep you awake at night if you’re a practice owner, but it’s all mixed in there. So anyway, I love having that on.

So insightful, such a wealth of knowledge. Let’s get into this episode 

Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast. Dr. Matt Salois how are you?

Matt Salois: I’m doing great. Good to see you again, Andy.

Dr. Andy Roark: You as well. I always love having you on the podcast. I was at VMG and I was hanging out with a couple of my friends. We were, I think I don’t remember looking at the program or what but your name came up and someone that I respect said You know, I would go wherever that guy was to hear what he had to say And it was just very complimentary statement about how insightful some people that I respect find your commentary.

So anyway, I just I was like, I gotta get, I gotta get Matt back on the podcast.

Matt Salois: That was a plant. That was the person that I put in there to do that. Yeah. No, just kidding.

Dr. Andy Roark: There was money, traded hands and, here.

Matt Salois: Yeah. No, appreciate that. It’s always great to be on here. I always feel like I’m on the premiere daytime talk show for veterinary medicine. When I come to talk to you, I love it.

Dr. Andy Roark: Well, thank you for saying that. I just, I genuinely am always interested in kind of what your thoughts are. You pay a lot of attention to the industry and which way it’s sort of going. And especially trends around practice ownership and independent practice ownership.

You are the president of the VMG, Veteran Management Groups, and you just generally have your finger on the pulse of, kind of, independent practice ownership in a significant way. And so, I’ve had this idea for a long time, and I, think independent practice ownership is a just, important. It’s a vital part of our culture in vet medicine and I just, I always want to support independent practices.

I mean, I don’t have any problem with corporate practices as well. I think that there’s a good mixture and there’s a lot of benefits for a mixed model like we have, but I still want to, I don’t want independent practice to go away. go away. And there for a while, there was so much consolidation and private practices were being bought at such a high rate of speed.

A lot of people were like, how far is this going to go? And we’ve seen a slowdown in that regard. It’s probably over, you know, increased interest rates and, money is more expensive to borrow now than it was. But, I just anecdotally, Matt, I had this feeling that we’re starting to see possibly an upswing in independent ownership.

We’re starting to see some consolidation has slowed down. We’re starting to see maybe some people who sold their practices, three, five, years ago are now sort of circling back around and saying, I think I’d like to make another pass at this. And boy, I’ve learned a lot of lessons. And now I’ve also got a nice chunk of change that I could play with to get something started.

It reminds me of, you know, if you’ve ever built something. And then you look back at it and you’re like, I love it, but boy, I could build this in one third of the time now that I know what I’m doing. And I hear that sentiment a lot from people who have sold practices. So let me sort of stop talking here for a second.

I just want to put it to you and sort of say, Do you share my optimism in the idea that maybe there’s a pendulum swing? And maybe we saw independent owners sort of exiting the field and maybe now they’re starting to come back in? Or do you think that’s maybe wishful thinking on my part? Yeah.

Matt Salois: No, I don’t think it’s just wishful thinking. It’s like this conversation was meant to happen, Andy, because you’re not alone in this. In fact Martin Traub Warner and I gave a talk at the PSI Symposium just this last past October on this very topic, you know, our title was Independence Day.

Why the conditions are right for a Renaissance of independent veterinary practice ownership. And it’s just on this entire thesis of what you’re talking about. And our genesis for this talk was, A year long experience that Martin and I were having what you just shared was owners who had sold to corporate coming back and reopening new independently owned practices because they could do it like you say, to the third of the time they could do it twice as well as they did it before, as well as some of the promises that I think that the corporate buyout just never, revealed themselves.

You know, and I think this is a Time tested story. You might’ve heard, Martin and I have heard it around, you know, I sold to corporate, they said nothing would change the culture, remained the same. They promised the practice to grow and some of the promises just didn’t happen and things did change. The culture of the practice wasn’t the same.

And they didn’t like the way things were left. And so it wasn’t just a do over for them. It was, Maybe amending the sins of the past and doing something again that they wanted to create this practice and how they felt a practice should be run and what a culture of that practice should look like.

Dr. Andy Roark: Well, so do you think that so I’ve heard this story before as well And I believe that there’s truth to it a lot of cases. How much do you think it is that? People who sold their practices again when you talk about corporates, that’s like talking about independent practices as if they’re all uniform And so just wild differences and so We’re, it’s, a big stereotype here, but, people have this have, you know, have that sort of story that they tell, but I gotta tell you, Matt, when I look at it, you know, having run businesses.

I don’t have clarity of what the next year is going to bring. And you know, and when you’re building a business and you’re putting things together, I do think that you could have the best intentions to say, we want to maintain what’s here. We want to maintain this culture, but none of us have the foresight to get in and you look and, who knows what’s going to happen in the world or who’s going to leave or, who’s going to come in or be brought in to run a region or a group of hospitals.

And there’s just so many moving parts. I have a hard time. In some cases, you wonder if that was ever really the plan. In most cases, I think it probably was the plan, but it just doesn’t shake out that way. And so, how much of that, if you own a practice and you sell it, how much of feeling that way is unavoidable?

Because it’s never going to stay the same as it was. Like, even if you ran it, it still wouldn’t be the same as it was. But, how much is that? How much it is, oftentimes, A lot of people and I go through this too, I a hundred percent, so I still work in practice. I was in the vet clinic today seeing appointments as an associate and I romanticize being an associate.

I’m like, Oh man, I could just go back and I could just roll in and see appointments and go home at the end of the day. But the truth is I can’t, I could never give up the control that I have. Like I just, I couldn’t do it, but I tell myself I could. And how much of it is that, you know, We, you sell your business and then only then do you really realize how much you enjoyed being the one who got to make decisions or you got to be the final decision maker.

Matt Salois: I mean, that has to be a part of it, right? Because, and we see this carry out in the data, AVMA and others have shown, they look at some of the wellbeing metrics around compassion fatigue and those sorts of measures compassion satisfaction, and they’re higher for, Practice owners and they are associates.

And while it may sound contrived in a way, but it’s true owning your own destiny, choosing the path that you’d want to walk. There’s value in that. There’s reward in that. And, you know, to your point around corporates and totally not meant not meaning to use the word pejoratively. I don’t think we should or should do that at all.

But they’re wildly different. And I think promises are made with always the best intentions, but this is part of the challenge with corporate ownership. You have to look at who owns that business, who owns that organization. And for the most part, there are plenty of exceptions, but for the most part, most of the corporate practices are owned by private equity groups in veterinary medicine.

And their whole fundamental purpose is, revenue return, to buy something, invest in it, and then sell it for a return. And so these practices change ownership hands, you see it time and again with NVA and others who are emerging the equity owners change, they’re selling to one another, and the priorities of those equity owners may be different, or how they strategize and build a strategy on practice growth could be wildly different than the previous owners.

And so it’s hard to have that consistency over time when the ownership of that business or that practice is changing hands too.

Dr. Andy Roark: That totally makes sense. Shifting gears a little bit. Talk to me about this conditions are favorable for independent practice ownership. Start to talk to me about what that looks like in your eyes.

Matt Salois: So I think it’s a number of things. The first thing and you alluded to it is just the economics of things. The fact that interest rates have reversed themselves definitely changed changes the tide in terms of what’s happening with consolidation. So the pace of consolidation has slowed way down.

The cost of capital is a lot different than what it used to be. Like you said before, money’s, money was really cheap and now it’s more expensive. Interest rates are coming down a bit from the highs of the last year or so, but we’re still amongst, you know, 20 year high interest rates for our economy, so it’s a lot more expensive to invest to gobble up practices, whereas before, particularly post covid immediately when interest rates were actually negative for a period of time because of some of the actions by the Federal Reserve and fiscal policy from the government, it made interest rates effectively negative, which is just odd.

We do have occasions of that in our economic history, but they’re generally pretty rare. So the incentive to sell a practice, I think, first and foremost, is a lot less than what once was. And so I think that’s slowing things down and creates a incentive motivation for a lot of independent practices just to focus on their practice and their growth rather than sell.

And on the flip side of that, From the corporate perspective, now the business isn’t investing in, in, in practices and growing through number of practices. Now they have to be business managers here. Now they have to be the owner and an operator of a veterinary practice. That’s how they, need to grow.

That’s a very different mindset. So I think that’s why we see a lot of corporate struggling right now. The other piece of this, the second piece I’ll say is technology access and affordability of technology has never been more accessible. Never been more affordable. And so the things that corporates could have done on their own because they had the capital, they had the cash the most expensive equipment, the best systems, the most cutting edge.

That’s not in the domain of the corporates anymore that I think independent small business in general. can access those types of technologies to incorporate into their practices. I mean, chat GPT is, it’s cheap, right? And so just the ability of AI and other types of technology to use that in your practice, no longer the domain for large businesses.

And the third and the final thing I’ll say is the level of support. And services available within veterinary medicine has matured greatly. And so, what that means for an independent veterinary practice is they no longer have to have their own tech department. They no longer have to have their own marketing department.

They don’t need their own bookkeeping. There are all these organizations and companies and services that can come in and support a veterinary practice in so many ways, allowing them just to focus more. On the delivery of the medicine and the patient care. So I think those are the big three ways that Renaissance is happening.

Dr. Andy Roark: Yeah. I like this a lot. I really, it’s funny, as I sit and think a little bit about the level of support and services, I think you’re, I think you’re spot on. 

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These courses are made to be taken. in groups, they have discussion questions. They are all about taking these trainings and getting them to apply to your practice, your culture. And your clients, whether it’s handling angry clients. Or being effective in the exam room. We’ve got some great training resources that you can grab and drop and use pieces of. 

They’re all broken up into five minute modules to make it super easy for you to use what you want and skip over what you don’t want. Tag them onto the end of staff meetings, or just make a whole staff meeting out of the trainings. Anyway, super flexible. It’s DrAndyRoark.com/teamtraining Gang, let’s get back into this episode. 

Dr. Andy Roark: You know, it was funny for a long time, the narrative was that you were going to see vet practices getting bigger and bigger. Yeah. because there was an economy of scale and you could have this technology if you had five, six, ten veterinarians using it.

So just imagine, you know, that we were all going to get CT scans. Well, one vet could never support a CT scanner, but if you had 20 vets, then they could, between them, they would have enough cases that would justify the cost and you could have this equipment. But that’s not really the way that medical technology has gone.

It has really shifted more and more towards being more and more portable, affordable, you know, sort of a subscription service type model. Um, And that, yeah, that’s, I think you’re spot on. I think that’s really powerful. I think the ability to outsource a lot of the services is really exciting in a lot of ways.

You really, you don’t have to wear all the hats because all of those things are readily available. I think that’s, I think that’s. I think that’s interesting. Can you speak a little bit about what the real estate market looks like for veterinary practices? It used to be that, you know, vets tended to own the real estate, or they tended to have standalone buildings.

And then there was definitely a shift in the, you know, late 2020 or early 2010s. We started to see a shift towards these buildouts in sort of strip malls, you know, kind of, startup spaces and things like that. Do you see or foresee build outs of those clinics in those types of rental spaces going forward?

Is that making practices more accessible if you wanted to get one set up or is it having a, you know, a sort of a net neutral effect?

Matt Salois: Yeah, that was a good one. And there’s a lot in there. I think, 

Dr. Andy Roark: Yeah, I kind of threw a lot, I kind of threw a lot at you around around where do we put vet practices?

Matt Salois: I think there’s a lot of opportunity in real estate. I mean, the real estate is one of those goat rodeos right now. I mean, it’s coming back, but it was a hot mess the last couple of years. In particular, you look at office real estate and commercial real estate, like there’s huge vacancies there as a lot of work from home, hybrid, remote, conditions evolved and are sticking for the most part. You still have some employers pulling back on that, but that’s another conversation. There’s a lot of vacancies, and so I think there’s a lot of opportunities for small businesses to take advantage of what a lot of real estate owners are doing, which is, you know, reducing their rents.

Or reducing some of their prices in order to have that real estate move. And the housing market, that’s a completely different story. And that’s a completely different market. But when you look at the available real estate for a veterinary practice, I mean, there, the availability is out there and many are building standalones.

And we’re having that within VMG. And I will say. I don’t know enough to know which one is dominating, but within our member practices, we’ve got members who are probably all over the place in terms of, you know, are they in a strip mall or in a, you know, organized commercial real estate venue versus are they standalone practices?

And we know, I know that there are plenty of members who are opening and expanding their own standalone veterinary practices too. I think there’s a lot of potential, a lot of opportunity there.

Dr. Andy Roark: Where do you think the new sort of wave of practice owners will come from? I mean, if it sort of shapes up this way, are these people who are later in their career who are circling back around? Is there a new wave of sort of entrepreneurs coming in who are maybe veterinarians? Who have come into vet school with this sort of dream or, I mean, give me an idea of what is, what demographics do you see sort of driving a potential resurgence in independent ownership?

Matt Salois: Yeah, all over. Quite honestly, which is a good thing. I’ll say again, bring up my VMG perspective as we’re seeing the membership get younger. And we have for the first time tipped majority female in terms of our members. And I’d have to look at the AVMA trends to see how that squares more generally with practice owners in the profession.

But it’s growing amongst that, that demographic makeup of being younger, being women. And you know, it sort of has to in a way because we’re more and more, you know, women dominated the profession and we are getting younger. We’re seeing this in the workforce, not just the veterinary workforce, but in our general workforce as you know, 11, 000 plus boomers are retiring every day.

So they will exit. Now, I’ve seen this in veterinary space more than in other industries and professions. The retirement age seems to be a lot, further out than, the typical you know, 62, 65, particularly when you look at some things like equine and food medicine, food animal medicine.

But we’re seeing that too. We are seeing owners step in who were previous owners, like we talked about, sold their practice, took some time off, decided that wasn’t for them. They were too early to too young to retire. And so now they’re opening new, businesses, new, veterinary practices, and they bring a lot to the table.

So I think we’re going to see a very strong mishmash who those owners are and what their demographic makeup is. Yeah.

Dr. Andy Roark: Do you think these people are going to be cranking out practices that are your standard companion animal practices like we’ve seen for the last 20 or 30 years? Or do you see a different sort of iteration coming down the pipes? 

Matt Salois: It has to evolve. I think there’s no question about it. In terms of the business model, in terms of, you know, how you run a veterinary practice, what you focus on and what you don’t, I think the specialization of veterinary medicine is going to continue that we’re going to see more and more

specialized, targeted veterinary practices, whether that’s at a, you know, specific specialization or even just focusing on, a specific species. You know, exotic pets, cats only, dogs only, those types of veterinary practices. We’re seeing that again within VMG that specialization, we’re, actually starting for the first time an urgent care group within our membership because they’re just growing number of urgent care, specifically veterinary practices. They’re not er, but they’re not general, right? they’re, urgent care. And so I think that caters to almost the consumer trend we see in the economy as a whole is people want the product or service designed for them.

And so you have this ability now to go onto a website and get almost anything Customized to what you’re looking for now. There are limits within health care, which is what veterinary medicine is. But as someone like Peter Weinstein keeps pointing out, it’s consumer health care. You know, so we’re at this hybridization of healthcare and almost, you know, retail in a sense that yes, it’s healthcare and it’s complicated.

And it’s also a consumer market in the sense that you have consumers who want things on their terms and they want it their way and veterinary medicine is going to have to adapt to that. And we are, it’s not easy, but we will, we have to.

Dr. Andy Roark: I do agree with that. I saw a lady today that was very well informed, and had very strong opinions about what she wanted for her pet and what she did not want for her pet. And, you know, it was not worth wrestling to the ground and her opinions were not, they were not detrimental in any way, but she was just, it was, I laugh not because she was wrong, but just because she was very particular and very certain about what she wanted and, you know, that’s not entirely new.

It’s definitely not going away. I think the age of sort of self education in pet owners is here to stay. I think I think we’re probably gonna be dealing with even a more educated level of pet owner than we have in the past going forward. Just accessibility, it’s easy to ask Chat GPT, what might be wrong with your pet and come in with a list of five things that are fairly well thought out.

Matt Salois: Yeah, exactly. Right. You know, gone are the days where you’re happy going into Target or Walmart and you’re pleased with the variety of what’s being offered to you now. And so I think, you know, again, you go to the Amazonification of everything where there’s thousands of options for that one product that you’re looking for.

Yeah. But people are wanting that. People are wanting to know that what they’re doing, what’s being provided to them, has been provided to them as an individual, this increasing individualization that seems to be occurring, you know, in our demography and in our markets.

Dr. Andy Roark: Yeah, when you look into your crystal ball five years from now, what do you see? I mean, do you see a steady steady march of sort of independent practices coming back in different niches? Do you see a specific type of practice really kind of jumping out ahead? What are you most optimistic about in the next five years?

Matt Salois: Oh, that’s a good one. I think most optimistic is that, you know, veterinarians are going to be in need of veterinary professionals in general, and it’s not just for the companion side. It’s all these things that veterinarians provide their skills and their talents towards on food safety, public zoonotic diseases, anything related to the one health arena.

Veterinarians are so important to our society. And I think the continued renaissance of the human animal bond. will grow. I mean, we’ve seen that. We saw that through COVID. Yes. I think that’s going to continue and sustain itself. I do think from a business and economic perspective, we’ve got volatile times ahead.

And so veterinary practices are going to have to, like any business, rise up to that challenge. They can’t just be about the veterinary medicine. I think gone are those days where you can be a practice owner and just be focused in your head, buried in the medicine. That is first and foremost, always the most important that you’re delivering the best care possible to patients.

The challenge now is that you’re going to have to be an astute, savvy business owner manager in order to survive. I think those volatile times because we’ve been through them, we’re going to, we’re going to see more of that and every business is going to need that fortitude.

Dr. Andy Roark: Yeah. Talk to me a little bit more about this volatility that you say. You say there’s volatility coming to tell me a little bit more about that so I can lose sleep at night.

Matt Salois: Yeah, so you could lose sleep at night. So I mean, I think, well, first of all, there’s always a business cycle and we’re going, we’re approaching the downside of our cycle. You see that with the softening of visits, yeah, there’s revenue growth, but it’s by far and large, you know, price driven. 

Dr. Andy Roark: Price increases.

Matt Salois: Right. And so there will be a market correction. That’s always the case. There is always a next recession. And we shouldn’t be afraid of it. It’s just part of the natural cycle. It’s hard not to talk about what’s going to happen next and leave out all of the complicated things that’s happening in our economy, in our society, the increased polarization, the inability of monetary policy and fiscal policy, excuse me.

To get us through some of those difficult times. We bought our way out of the oh, eight recession. We bought our way out of COVID. You see this when you look at aggregate debt levels in our country. And so there is a ceiling here in Japan hit it and we saw. The stagflation that Japan experienced for quite literally decades and only now, you know, since the eighties, only now, really, are they coming out of it and potentially seeing a new era in their economy and that’s my worry for, our, economy as well.

We’re also, we talked about the demographic change, that’s going to be hard. We’re going to see the non working population explode relative to the working population. And so what that means for services like social security and medicare, there’s going to be a funding problem. And, you have the confluence of these forces.

Excuse me, the doorbell rang and the puppy, the little puppy that we got for Christmas is, uh, barking up a storm. She was napping so peacefully next to me and now she’s on guard dog alert. That was sweet little Molly. She’s actually quite sweet. So those are the issues that we’re facing and they’re all going to be kind of at a confluence in the next five to 10 years as these forces are coming together all at once.

Dr. Andy Roark: Well, I think that’s no, I think you’re spot on. I appreciate you sort of sharing that. I think it makes sense. I I, love owning my own business. It’s not easy. I am surprised by how not easy it is sometimes but it’s rewarding and it’s something that I really have enjoyed. So anyway, Matt, thank you so much for being here. Where can people find you? Where can they learn more about VMG?

Matt Salois: Yeah, that’s great. A joy to be here. Talk to you Andy. I always get so much out of our conversations. I’m available LinkedIn. I’m active on there. Message me really to reach out to me. And you can learn more about VMG at our website, myvmg.com.

Dr. Andy Roark: Great. Well, I’ll put links in the show notes, guys. Thanks for tuning in, everybody. Thanks, Matt. Take care of yourselves, everybody.

Matt Salois: You too. Take care. Thank you.

Dr. Andy Roark: And that’s it. That’s what I got for you guys. Thanks so much for being here. Thanks to Matt for being here I’ll put a link to his LinkedIn and the VMG website down in the show notes And that’ll be that gang. Take care of yourselves everybody.

I’ll talk to you later. Bye

Why Do They Leave? Why Do They Stay? Retention & Attrition in Vet Medicine

by

Dr. Jessica Vogelsang discusses the latest findings in veterinary retention and attrition. She is joined by Dr. Andy Roark as they dive into the American Animal Hospital Association’s new white paper, “Stay Please.” Together, they explore both expected and unexpected insights gathered from a survey of over 15,000 veterinary professionals. Tune in to discover the reasons behind the departures and commitments of veterinary professionals, and what these trends could mean for the future of the veterinary field.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

AAHA White Paper: https://www.aaha.org/practice-resources/research-center/white-paper-form-the-path-to-increasing-retention-in-veterinary-medicine/

All Dogs Go to Kevin by Jessica Vogelsang: https://www.amazon.com/All-Dogs-Kevin-Everything-Veterinary/dp/145555491X

Jessica Vogelsang on LinkedIn: https://www.linkedin.com/in/jessicavogelsang/

Uncharted at HiVE in Minneapolis: https://unchartedvet.com/conflict-management-training-navc-hive/

Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jessica Vogelsang is a noted veterinarian, internationally recognized speaker, and bestselling author of All Dogs Go to Kevin. She serves as the Chief Medical Officer at AAHA and is the founder of Pawcurious Media, established in 2009. An early adopter in utilizing the internet for veterinary purposes, she successfully built an online community, influencing hundreds of thousands of pet owners globally. Her achievements include launching several veterinary brands and founding the Veterinary Telemedicine community during the COVID-19 pandemic. Besides her role at AAHA, she is an active board member of the Mark Morris Institute and the Veterinary Virtual Care Association.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host Dr. Andy Roark. Guys, I am here with the one and only Dr. Jessica Vogelsang saying she is the chief medical officer at the American Animal Hospital Association or AAHA as it’s often called. She is here talking with me about a new white paper that AAHA just published.

Put it, put out, it’s called, officially it’s called Stay Please. It is a retention attrition survey about why people leave the profession, why they leave the clinic. Are they thinking about leaving the clinic in the next year? And are they thinking about staying? If they’re staying, why are they staying?

What makes them want to stay? And so we have this really nice conversation about why people leave the profession and why they leave their clinic and then why they don’t leave and what matters. And so it’s just sort of the tip of the iceberg, but I think it’s a really good conversation to start thinking about what people care about and how do we keep people? How do we keep them in our practice? How do we keep them in our profession? So anyway, that’s what we’re talking about. It is a good time. Let’s get into this episode. 

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. Jessica Vogelsang, how are you?

Dr. Jessica Vogelsang: I’m great. How are you doing?

Dr. Andy Roark: Man, I’m good. It’s so good to see you. Is this your first time on the Cone of Shame podcast? I think it is.

Dr. Jessica Vogelsang: Yes, it is!

Dr. Andy Roark: That’s amazing. 

Dr. Jessica Vogelsang: I remember you back when you were doing YouTube in your basement.

Dr. Andy Roark: Exactly. Well, that’s where I’m, that’s where I’m recording now, old YouTube studio in my basement. I was thinking you know, I always sort of reflect back on when I met people that I interview. I met you in like, 2012, I think, and we were at the Starbucks in San Diego, and I, I reached out to you because I was a huge fan of you, and you were writing, you were writing your blog, Paul Curious, and this is when blogs were really blowing up on the internet and all of that sort of stuff, and it was a long time ago.

Dr. Andy Roark: It was a long time ago. It was a different world. There was no TikTok. It was all just writing blogs on Facebook. And you, you are such a wonderful writer. You, I always enjoyed your perspective so much. You have a book. It’s one of my favorite veterinary books. It’s called All Dogs Go to Kevin. And so anybody who wants kind of a fun it’s, it’s fun, honest read on, it’s sort of a humorous look at, at vet medicine and you’ll sort of your life as a general practitioner and I just, I highly recommend it.

So anyway, you are now onto bigger, bolder things. I’m not saying better because I really liked your blog, but you’re on to bigger, bolder things as the Chief Medical Officer at the American Animal Hospital Association.

Dr. Jessica Vogelsang: That’s right.

Dr. Andy Roark: And I saw you recently, and I was asking you about this initiative that I’ve seen from AAHA that I wanted to kind of break down and I didn’t realize what a big hand you had in it when we first started talking.

So AAHA put out a white paper. It is a retention attrition survey. It’s called Stay Please. It is a— it is a survey mechanism for AAHA hospitals all about basically employee retention and what makes people stay and what makes people leave. And so let me, let me just sort of pause here for one second and kind of hand it over to you for a second. Tell me a little bit about the survey. Tell me about what it does. Tell me about what it was intended for. 

Dr. Jessica Vogelsang: That’s a great question. During the pandemic, McKinsey put out a big survey called the great the great attrition kind of studying all the different factors that make people leave their jobs or make them want to stay. And so our CEO Garth Jordan came to us. We’ve been interested in doing some research anyway and said, what do you guys think about this, modifying this for a veterinary audience. And I said, I’m in, because what we had never seen up until that point was a survey that asks people not only why are you leaving, but asking them why are they staying? And we hadn’t split it up by job roles. So we decided if we’re going to do this survey we really need to get information from people.

What job role do you have in the clinic? And we broke it down into six different groups. And also the other thing that was incredibly important to me was to include people in the survey who left because that was the other narrative that I think had been out there was that people leave by choice. Rather than I’m really, really sad to leave and I really don’t want to.

And so we really wanted to include those people. I was really inspired to participate in the survey. When I was at the moms with the DVM encouragement conference, that’s Julie Busby’s conference that she does every year. And I was looking at this room of moms, many of whom had left the profession and

I think I had been sort of beaten down and disheartened thinking the profession doesn’t want me back. They’re not making a house that’s built for me. And that made me really sad because I’d been there too. This idea that I want to live here, but this isn’t a livable situation for me. So what can we do to make it better?

And that was really the Genesis for me of wanting to be involved in this survey. And we were so excited when we put it out, we normally get About 2 to 3,000 respondents for a typical survey. We had 15,000 people. You couldn’t stop people from responding. They had a lot to say.

Dr. Andy Roark: Yeah, that’s amazing. So I love this, I love this statement, not making a house that’s built for me. Talk to me a little bit about that. So, so that’s sort of, I totally understand. Julie Busby does a great job. Her mom’s with a DVM conference. I’ve heard wonderful things about it. Tell me a little bit more about kind of what the house is not built for me.

Did that bear out in the survey results? What does that sort of look like when you say it?

Dr. Jessica Vogelsang: Yeah, you know, I, I think and again, I’ve been out for a while, but I remember going through vet school and that there’s a certain amount of assumptions. Right? Like if you’re going to vet school, you want to own a practice and, and that’s what you’re going to do. And what does owning a practice look like?

Well, how does that bear out for your life? And sort of a set of assumptions, maybe that you’re not the primary caretaker for someone that you’re not going to have these other challenges or obligations in your life that you will always put veterinary medicine first every single time in every situation for the entirety of your career.

And if you are not able to do that. For some reason, be it temporary or permanent. you’re out, right? You’re out. And once you’re out, you can’t come back. So, so there’s this, all of these competing narratives that veterinary medicine is only allowed to be a part of your life if you’re willing to commit 100 percent to it.

And, you know, whether or not that’s true, I don’t know, but that was, that was always sort of how I felt. And when I was in situations in my life where I needed to take some time off to take care of family members because I had a baby. It was always sort of this sense of disappointment. Great. You know, another one bites the dust rather than like, cool, you know, we’ll see you in six months.

We’ll see you in, in a year when you’re ready to come back bigger and better. And so we’re doing a much better job of, I think, allowing people that flexibility and helping them see that there’s a place for them, but in my opinion, it was very hard one. It wasn’t that we have as a profession ever built that house for them. Like they had to fight. We had to fight our way back in and say, I’m still here. I still have something to give, boss.

Dr. Andy Roark: Well, it, it totally makes sense and I, and I love that this sort of inspired you to, to sort of pay attention to the voices of the people who had, who had left the career or left, left the profession or left their jobs and that, that, that totally makes sense to me. Was that bared out in the results when you look at attrition data, Jessica?

Is that kind of the feedback that you started to see? Tell me more kind of about what this, tell me more, I guess, about why people leave. Yeah. Yeah.

Dr. Jessica Vogelsang: So it’s interesting. We have the data broken down sort of as a monolith and then broken down by job roles. And so when you dig in, we had 15 different factors. The reasons people leave far and away, and this shouldn’t surprise anyone. The number one reason people leave is cause you’re not paying me enough.

You know, I, I, I can’t survive on this. And also unsurprisingly, although it was the top factor for pretty much everyone, it was the top factor by orders of magnitude for our credential technicians. And some of the, some of the things that they said in the survey, like the quotes you get back would, would break your heart.

You know, like I, I, I, I love this profession, but I have to eat. I can’t keep stealing peanut butter from the treat jar in the back because I can’t afford groceries. I’m like, Oh my gosh, what, what is wrong with us that, that we’re doing that? And so it really sort of reinforced a narrative to me that, People are aren’t leaving because I decided the field wasn’t right for me, or I didn’t love it.

I left because there is an untenable situation. So the other factors we don’t work as a team. You know, I don’t feel appreciated. The leadership isn’t caring. You know that all of those top factors are similar across job roles, just in different different degrees of importance. But it gives us a really clear blueprint for if you want people to stay, you know, here are the things that that you need to do that you need to make better for them so they won’t want to leave.

Because most people And so we, so we asked them, you know, are you planning on staying? Why are you planning on leaving? Why? And if they said that they were planning on leaving in the next year and 30 percent of the respondents said, I’m thinking about leaving and we know statistically 25 percent of them actually do 25 percent turnover in this profession across all job roles, which is huge.

But you asked them what they wanted to do, and most of them were looking for another job within the profession. Very few people were like, I’m out, you know, they were looking for either a job in another clinic, but half of them were doing that. And the other half were saying, I’m looking for a job in industry.

So people were just really, we’re tied. We’re tied emotionally to this vet profession. People don’t get into this for the same reason that people go into other jobs. Like there is a deep emotional connection to the work that we do. People find it very meaningful. And so when they leave. I think most of us are trying really, really hard to still keep a finger in it.

Now, you don’t put years and years of your life into a profession to leave after five years, but that’s what’s happening with our technicians. The average length in this field is five years. Like how that’s, that’s not good.

Dr. Andy Roark: Yeah.

Dr. Jessica Vogelsang: That’s a big problem. Well,

Hey guys, I just have to jump in with incredible news. I will be traveling with the Uncharted Veterinary Conference team. That includes Stephanie Goss and Maria Pirita we are going to Minneapolis for the NAVC HiVE conference that is there. This is on June 15th and 16th. Guys, we are doing a one day Uncharted conflict management training program. 

That’s right. And it is included with the cost of HiVE. All you have to do is register for the HiVE conference that’s $99 for two days. One day, you can spend it with us, bring your team, send multiple people from your practice, put them together. We’ll put them at round tables. We will have them working together, talking about conflict management. 

We’re going to take them through a whole day. This is not a series of lectures. It’s not, they’re going to go to one and they’re going to do something else. Nope. Check the box register for the Uncharted event at HiVE. And you will spend the day with us. And I guess you’re never going to see an Uncharted event that is a day long. 

That is $99. Again, like this is the best price you will ever see on conflict management. So anyway, if you are anywhere near Minneapolis, June 15th and 16th, Come to the HiVE event it’s $99 and you get a day with Uncharted. If you register for it and the other day, you can use it HiVE and get their amazing CE for technicians and managers. Anyway I’ll put links in the show notes. 

You should learn more. I’m serious. If you were within hours of HiVE, there was never going to be a chance for you to sign up multiple team members come together. And do conflict management training as a group. This is a phenomenal opportunity, please don’t miss it. If you’re able to make it, it’s going to be great. 

Let’s get back into this episode. 

Dr. Andy Roark: Were there big drivers that were role specific? So, so I totally understand that, you know, there’s basically the same sort of drivers and they’re sort of re prioritized across roles, but when you say that pay is an orders of magnitude larger concern for our credential technicians, that, that tracks to me.

Were there other items like that where you said this role specifically is being disproportionately impacted by this factor or, or was it otherwise mostly just sort of a reorganization of, of The, the general factors.

Dr. Jessica Vogelsang: I think far and away, you know, the, the pay is, is the big one. And so, You know, what that means is as soon as you get that part sorted out, right, then you have a lot more leeway to figure out what the rest of the factors are. So it’s something that was really interesting to me was when you look at retention factors the top three retention factors for associate DVMs and credential technicians, they map perfectly one to one.

This is a cohort of people who are in it for the same reasons and care for the same reasons. So meaningful work, modern medicine staff works as. And so the thing that was different was that we’re not You know, the associate DVMs for the most part weren’t saying, I can’t afford a car. You know, that’s the sort of thing that our credential technicians were saying, but their attention factors were very, very similar.

These are people that were very motivated by the same things. And the other thing that really, really jumped out to me was talking about, Your, your CSRs and, and support staff, the professional development was a huge retention factor. And oftentimes when I’m presenting this research or talking to to groups, I’ll say, how many of you offer continuing education or professional development for your CSRs?

And a fraction, a small fraction of the room will raise their hands. And so the sorts of things that we were hearing from them is it. Clearly, I’m not in this for the money. I could make the same amount of money at at a grocery store or a retail job and probably be a lot less stressful. I’m in this because I love it.

But in return, I would really love if you would help support my professional development so I can be better at my job. There’s very specific job specific roles. And I want to I want to do better. Help me.

Dr. Andy Roark: Yeah, Yeah, that, that, that totally makes sense. What is it? What do you think it means Jessica, when, when, you know, number three, the staff works as a team? Do you get inside into, like, what, give me an example of what that looks like when a staff works as a team versus when they don’t. Is that everybody is, is working off sort of a unicor–, a uniform treatment protocol?

Like we’re all kind of practicing the medicine, like, is that, is that, is that a workplace culture response? What do you, what do you think that means?

Dr. Jessica Vogelsang: Yeah. I’m so glad you asked that actually. And I swear this wasn’t a plant everyone. We actually just had a meeting about that this morning and trying to figure out how we can research that more because we were pretty intentional when we asked that we didn’t define it. And so the people who responded all had something different in their heads.

So now we sort of have a framework for the next white paper. What does that mean? Team based medicine is a very specific defined discipline specifically on the human side. And I think there are some groups in vet med that are really starting to pick at that. But we have a lot of work to do in order to define what that means.

For me personally, it’s about creating a culture that is family centered practice, right? You put the patient and their family members at the center of every decision that’s made and then everybody else is supporting that. And so everybody on the periphery has to figure out how to work together to support that as opposed to, I think, some of the ways that we maybe center ourselves right now

in, in that decision making process or how things function in the clinic. So it’s just a very different way of thinking, but we’re going to spend some time teasing that out.

Dr. Andy Roark: Yeah. That, that. That totally makes sense. I just think, I think it’s when you get feedback like that, I often say, what exactly does that it, does it look the same for everybody? So, so we’ve talked a bit about, about sort of the reasons people leave and we talk a bit about the reasons that they stay.

I, I, I love the idea that the, the vets and the techs both, both are top three are the exact same. That, that totally makes sense to me. I think, I think, you know, it’s funny with a meaningful work as number one, I see as we’ve had sort of corporate groups moving into vet medicine, and all corporate groups are different, but I have seen conflict in that way where there’s a lot of a lot of companies will use sort of operations language to try to talk to the doctors and the technicians and it doesn’t go well because they’re not here to hit your operation numbers.

They’re here for a much more sort of heartfelt purpose. And it’s just that has been a communication like conflict that I’ve kind of seen over and over again in the last couple years. So that totally tracks number one for when you start sort of looking at these things, you know, one of the things about the survey that I think is interesting is, you know, what do you do with it and where do you go with it?

Can you talk to me a little bit about, you know, I know a lot of people are listening because they’re like, well, you know, I wanted to hear about retention in the practice and what can I do? How can I assess my own practice and what can I do to try to, to try to keep people here? Can you talk to me a little bit about, about best practices?

Dr. Jessica Vogelsang: Yeah. And this is all, it’s so early stages in terms of the work that we have to do. So, you know, at AAHA, our whole purpose and mission is to simplify the journey to excellence for veterinary practices. So it’s not about hitting a mark or hitting a brass ring. It is about doing better every day. And so what we need to do and what our challenges as an organization is, again, we have this information in front of us.

What next? So how do we help people regardless of whether you’re a practice manager who wants to help their team function better or whether you are maybe a new grad trying to figure out is this, how do I figure out what the right job is for me? What questions do I need to be asking my interview? I want to build out a tool set that help people explore all of those things.

So you know what to ask for because we all know how to ask for salary right now. I think it’s, you know, at the very least we’ve done a better job at helping people ask for that. But as we know now, that’s just the beginning because there are lots and lots of people who picked a job that paid the most.

Who are wretchedly miserable that there’s other things that matter. How do you know how to ask for those things? How do you know how to determine whether or not you’re going to be able to get them at the job that you’re at? So it’s, there’s a lot of work ahead of us, but it’s energizing. It’s so energizing to me.

Dr. Andy Roark: Do you think that it’s possible to teach people that? I’ve been thinking about this a lot because, you know, when I work with practice owners and you know, they’ll be talking about recruiting or hiring veterinarians, whatever. And it sounds like so many people come with a salary number and that’s it. Like, that’s all they got.

It’s like, I don’t know what else you do, but this is the financial number. And it’s just, it’s interesting to look and to say, I’m not, I’m not shaming anybody for a salary number they come with but. But I, I don’t know that that number is really what is going to make people happy versus the culture of the place that they’re working, other things like, like time off to support the continuing education support, all of those sorts of things.

And I don’t know, it’s, it’s sort of a nuanced conversation, but I still, I continue to see people that hold so tightly to the money and I think when you jump back to what we were talking about the very beginning, when we look at the number of, one reason that people leave, I think that justifiably there’s, there is concern about money in vet medicine and what people get paid.

So again, I’m not, not trying to knock that, but I, I’ve been rolling around a lot trying to have good, productive, nonjudgmental conversations about what makes people happy and practice beyond salary. But I don’t know that there’s a good way to approach it.

Dr. Jessica Vogelsang: Well, it’s not an either or conversation, right? It’s a yes. And so you need to have a living salary and you need to have these other things. And that is part of the challenge because I don’t, you don’t necessarily know how much you need something until you’re in the middle of it. So some of that is time and experience.

I think mentorship and we have so many great programs out there that are starting to help people understand and develop that having a mentor who can maybe help you get some clarity on that can be super helpful. And one of the other things that really jumped out at me as one of the factors that we asked about for folks was flexibility.

And the only group where flexibility was a top factor in retention was associate DVMs. And you know, you can theorize about why that is, but that’s a group and I’m thinking again about the moms at the DVM group. That’s huge. Do people even know to ask for that? Is it something that you know you’re going to want in, in your job or career?

And so those are all the conversations that we still need to be having. And so how do you offer that? If you are a team, that’s really proud of what you have to offer. And because we hear that all the time, I can’t compete with the salaries that maybe another clinic in town is offering. How do you help people understand?

How do you quantify the value of the rest of it? And it’s not about, you can’t really put a dollar amount on those things. So I think we have to start telling those stories and finding those people who, at the end of the day I think meaningful work is the hardest thing to quantify. That’s going to look different for you, for me, but we have to be asking ourselves what makes life meaningful, and to me, you know, the reason that that I love being in vet med.

And the reason that every time I got kicked out, I came back, it’s like, there’s nothing else I want to do. Meaningful work to me is doing anything to honor that human animal bond. So when I was in the clinic, my goal was to make sure that that, that pet and that owner left. That that somehow improve their outcome, right?

That means a lot of different things. And there’s a lot of things that have to go to play to make that happen. And so now at AAHA, I want people to stay in this profession and find value and find meaning in it and being in an organization where I’m in. The ability to help tell those stories and elevate those conversations that is meaningful to me.

Dr. Andy Roark: Yeah, it sounds like it sounds like you have a lot of sort of next steps, you know, with this, with this program as we look at it.

It’s it And funny, you know, you and I talked about with you, what’s it mean when we say the team works well together? I think you can equally just ask, you know, what does it mean to have meaningful work?

Like, do do is that uniformly defined? I’m sure it’s probably not. But talk to me a little bit. Where do you see this going? Jessica? Like, what are sort of the next steps? Where does this research take you?

Dr. Jessica Vogelsang: Yep. So, next steps for us are starting to build out some of those, those tools for people. And so asking people, figuring out which of these things do we want to focus on first? What do people need? Who is the audience that we’re trying to give these tools to, right? And I think employers and employees both have a different set of tools that they need.

So we’re going to be talking to people and finding out what’s the number one thing that you need help with right now is understanding what understanding what teamwork looks like is a big one. So I think we’re probably going to go in that direction, helping to quantify what What their pay means.

That’s very challenging to do for a lot of different reasons. But just helping people understand, you know, we did a separate survey a couple years ago where we were asking everybody in the team. What do you think your technicians make? What do you think they should make? And what do you want to make?

And so for the vast majority of technicians, what they were asking for wasn’t like twice what they were making. They’re saying I need 5000 more. I need 5000 more, which, you know, when you look at what it costs to lose a good technician, it’s going to be a lot more than that. So even just starting with some of those basic conversations, do you even really understand what the problem is and what you need to do to solve it in the short term or long term?

So. So that’s a really long answer to a short question, but this is a lifelong, like, I could write out the rest of my career just trying to figure out what all this means.

Dr. Andy Roark: I’m going to put links in the show notes, everybody to the white paper. You’ll be able to check that out. I will link to the AAHA website just so people can can have that. Jessica, where can people follow you online?

Dr. Jessica Vogelsang: I am on LinkedIn a lot, so feel free to look me up there. I love to have conversations and talk with folks about all of these things. It’s really grown as I, because I know Andy, when we first when we first met at the Hilton or wherever that was you were just asking me how to get on Twitter. That’s how long ago it was.

Dr. Andy Roark: How, yeah, how, it’s– there’s new thing called Twitter, really interested in it. Yeah yep It was that, back in a much simpler, more naive time online.

Dr. Jessica Vogelsang: So now we’re all LinkedIn.

Dr. Andy Roark: Well, thank you so much for being here. Guys, thanks for tuning in and listening. Take care of yourselves, everybody!

And that’s it. That’s what I got for you. Thanks so much for being here, everybody. Thanks to Dr. Vogelsang for being here. She is a dear longtime friend of mine.

I’m so glad to get to have her on the podcast. Anyway, guys, take care of yourselves, everybody. Be well. I’ll talk to you later on.

Multiple Dogs with “Big Feelings” (HDYTT)

by

Board-certified behaviorist Dr. Chris Pachel returns, this time to address the all too common issue of the barking fence dogs, specifically when the two feed off each other. On this week’s episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark and Dr. Chris Pachel discuss the underlying behavior behind this bark and offer practical advice on how to reduce stimulus and modify problematic behaviors. They also provide tips for veterinary professionals on guiding client conversations about these challenges. This episode is a must-listen for insights and strategies to improve handling of similar cases in your veterinary practice. Let’s get into it!

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Dr. Chris Pachel: www.drpachel.com

Instinct Dog Behavior & Training: https://www.instinctdogtraining.com/

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Chris Pachel is a board-certified veterinary behaviorist and is the owner and lead clinician at the Animal Behavior Clinic in Portland, Oregon. Dr. Pachel lectures extensively worldwide, teaches courses at multiple veterinary schools in the United States, and has authored numerous articles and book chapters for veterinarians and pet owners. He is a sought-after expert witness for legal cases and serves on the Editorial Advisory Board for dvm360. He is also a Vice-president of Veterinary Behavior for Instinct Dog Behavior and Training, as well as co-owner of Instinct Portland, which opened in the fall of 2020.

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I got a super fun one here. Talking all about the neighbors, talking– all who are wonderful people.

They are wonderful people. They have two dogs that have big feelings. As my guest says today, they have big feelings. They are the two dogs that rattle the doors and bark their heads off at the edge of the fence. And one of them jumps over the fence and comes out in the road sometimes. And it’s kind of a behavioral nightmare for some very nice people. And anyway, we wade into this. What do you do about multiple dogs with big feelings? and that’s what we’re working on today. So anyway, my guest today is Dr. Christopher Pachel. He is a board of vet behaviorist and we get into this case. And I love this conversation, a really good one. I, if you like behavior, you’re going to have a good time. Buckle up, let’s get into it.

Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. Christopher Pachel. How are you?

Dr. Chris Pachel: I am doing fantastic. Dr. Roark, how are you?

Dr. Andy Roark: I am great. For those who don’t know you, you are a boarded veterinary behaviorist. You are a wonderful speaker. You have been on the podcast before. I just, I love having you on and getting to talk with you. I have got a case for you that I really would like to have your insight on. And I was wondering if I could run it by you.

Dr. Chris Pachel: I would love that. Bring it on.

Dr. Andy Roark: Okay, there’s, okay, these are, I have some neighbors I have some neighbors, and they have poodles, standard, you know, full size poodles, and they had two poodles, and those dogs. I don’t want to say they were bad, but they were hard to control, you know what I mean? They– it took both owners to walk the two of them, and if they saw another dog, forget it.

They lost, both of them lost their minds pulling at the leash. They have a fenced yard, but it’s a fenced front yard. So whenever you walk in front of the house, if they’re inside, the front door shakes. Like there’s a, you know, like there’s some supernatural force manifesting inside the house. Just, you know, and you hear them Just barking their heads off, and it just, it sounds like a bomb is going off when you walk past.

And if they’re outside, they are all up on the fence, just snapping, barking, just slobber flying, just the two of them together. And then, one of them died, which is sad, one of them died of old age, and they got a Poodle puppy and Chris, this poodle puppy has immediately adopted the exact same behaviors and they were back to having two of them rattling the door.

The young puppy is spry enough that it shoots over the top of the fence at the upper corner and then it’s in the road and I’ve got my bad goldendoodle and skipper who’s bad and then it’s just it’s complete pandemonium and it happens about once a week and everything and I’m looking at these people who were nice people.

But they are so overmatched by these two dogs and I am convinced because of the one going out and the other one coming in and immediately going into this that there is this, that there is this training behavior issue that is 100 percent being exacerbated by the two dogs. They are wi– they’re winding each other up.

I feel like they’re feeding back and forth between the other ones. The people haven’t asked me for advice yet. I don’t think they know I’m a vet. And I’m not telling ’em. But they have not asked for my advice yet. But I do roll around in my head as I walk past dragging my dog behind me. 

What do you think about wading into behavioral cases or things like this where you have multiple dogs and they clearly feed off of each other? Can you talk to me about advice on fighting a multi front battle to try to get those things under control?

Dr. Chris Pachel: I love this setup on this, Andy, too. Just thinking about all of these different elements and my brain is sort of piecing all of these things together. Right? Even from the standpoint, I can imagine that sort of sense of like, sadness when one passes and then maybe the, short lived optimism. Like, Oh, maybe this is, and then, no, we’re right back where we started.

Dr. Andy Roark: Optimist and then yeah, she’s

Dr. Chris Pachel: Now here’s another 14 years where we’re just destined to go down the same pathway all over again.

Dr. Andy Roark: And the young one is limber. He can get out of the fit. It has not gotten better. It’s gotten worse because now he’s in the road and I have to wrangle him.

Dr. Chris Pachel: So, a couple of things that come to mind for me here is, you know, we know that, you know, first things first. So we mentioned, you know, the fact that these are bad dogs, right? Probably not the best terminology on that, gonna call you out on that.

Dr. Andy Roark: No, they’re, yeah, they’re not.

Dr. Chris Pachel: I’m going to invite you into trialing to a different terminology.

One, I would say these are two dogs that have very big feelings about the world in find themselves.

Dr. Andy Roark: They do. Exactly! They have very big feelings. I agree with that. They manifest their presence in a large way.

Dr. Chris Pachel: Um, the interesting thing about that is whether, you know, even before we get into the two dog scenario here is that when we have a dog who has really big feelings about the world that they’re in, they’re going to be motivated to behave in certain ways. So, in this case, if we have a dog who is concerned or really worked up by a passer by the goldendoodle coming down the walkway, right? So they have really big feelings about that and that creates some stress. They get really worked up about things. They do what comes naturally for a lot of dogs, especially in that scenario you described with that fenced in front yard That they rush out to the fence line and then by, you know, they carry on and we’re running the fence line. And eventually, what do you and your dog do? You go away. Yeah, you, of course, are going to go away anyway. But the dogs on the other side of the fence don’t always know that. And so what can absolutely happen, either just by the rehearsal of going through the motions, or worst case scenario, not only did they go through the motions, but it worked.

And so now we have an outlet for arousal and a reinforcement loop that the thing that was stressing them out went away, which strengthens the behavior that immediately preceded it, which means we are more likely to engage in that sort of running, barking, charging, —everything. I almost required a little bleep there, but there’s a, you know, 

Dr. Andy Roark: (laughter)

Dr. Chris Pachel: The BLEEP show that is that front yard in those moments, right, is something that is sort of being reinforced based on the circumstances they find themselves in and that could happen whether we’re talking one dogs or two with the two dog scenario where that often gets into, you know, especially when we see this kind of perpetuating of the same problem or the repeating of the same problem that either means that we have an environment that is shaping the animal’s behavior in that same direction, whether it’s this dog or the next one, the environment is more conducive to these behaviors emerging than it is anything else.

Or and we may have some social facilitation that’s happening there as well, where if you’re a naive little puppy who comes into that world and you say, I don’t really know what the lay of the land here is, but my big brother or sister seems to be really worked up about that thing when they go by. So I guess that’s what we do here.

I’ll come along for the ride and lo and behold, boom, we’re right back where we started from with that reinforcement history and we’re off to the races.

Dr. Andy Roark: Yeah that, so okay, so a hundred percent I actually you hit me like a ton of bricks because you were spot on. I and again, I’m walking my dog. It’s like– I don’t, I can’t, Chris I don’t have time to stand in front of their house until everything I got places to be I got stuff to do but to your point like I am captive and positive reinforcement and it just never dawned on me that me dragging, my own dog past their house was, supporting this.

But it totally makes sense. Can you unpack for me a little bit more what you mean when you talk about, is the environment conducive to this behavior? Give me an example of what that looks like, if you don’t

Dr. Chris Pachel: Yeah, absolutely. So it was the thing that jumped into my head when you first mentioned fenced in front yard when you need to be walking by, you know, and you’re out in the public. So you’re in the public space. You have the right to be there. You have the freedom to be there in that public space. You’re not intruding.

And yet. Having that fenced in front yard puts those dogs right up close to where that trigger would be for them, and whether that trigger is a person or a dog or vehicles going by or any other arousal stimulus, the environment allows them to position themselves right up next to it, which is really helpful.

You know, it’s going to be a more challenging situation for a lot of dogs to navigate. So in that scenario, just the freedom to put themselves there would be an example of that. I would say the same thing if we had a client who was concerned, and maybe these clients have the same reaction here that if somebody comes through the front door and the dogs are jumping all over the visitors. The environment is allowing that to happen. And again, when I say the environment, I mean all of the pieces, right? The fact that the dogs are not on a leash, that they’re not behind a baby gate, that they’ve not done proactive training. All of these things now create an environment in which the behavior that comes naturally to that dog in that moment is allowed to occur based on the lack of environmental control being exerted at that moment. 

Dr. Andy Roark: This all makes sense. When I think about this family, I, this seems like an uphill battle to me, Chris. Because, this is how their house is built. You know, like, this is where the fence is. And they’ve got the, you know, the glass, it’s not really glass. But it’s the clear door, front door that the dog’s gonna kind of see out of.

And now we’ve got these two dogs, and this sort of behavior has been established. It feels like everything is stacked against these two. And the owners, they don’t like when their dogs bark at, because we have a neighborhood where people walk their dogs. That’s what they do. And so I’m certain that their house explodes once an hour.

You know, most hours of the day. 

Hey guys, just want to hop in real quick and to let you know about my exam room communication toolkit. That’s right guys. I have team training on exam room skills. I don’t think there is a better way for you to train your team than for the people going into the exam rooms to get together as a group. Get some education and then talk about how they do it in their practice. 

Do you guys do this? What does this look like? Can we talk about a time that you saw somebody do this in the practice? What did it look like? If you want to actually get people to change what they say and how they behave, you should train them together so they can discuss it. And that is why this training is made to be done in groups. It’s made for teams. 

I have 17 different tools. That I lay down and they’re. Each module, you can break them up, you can tag them onto a staff meeting five minutes, and then they all have discussion questions that will help you get your people to talk about what they do, but you can get the door open. You can get people being honest about the experience they have in the exam room, and you can get them making changes and raising their game in a way they feel good about, and not in a way that they feel scolded or they feel like they’re not doing what they’re supposed to do. 

It is a very positive way to learn and encourage. And so anyway, that is at DrAndy Roark.com. I’ll put a link in the show notes, but it is my exam room communication toolkit. I hope you’ll check it out. 

Let’s get back into this episode. 

Dr. Andy Roark: Can you start to talk with me a little bit if you were in this situation or you were looking at these sort of environmental factors of this behavior is established and, it’s sort of probably been trained you know, early on.

And now we have two dogs in there, both exhibiting the behavior and the environment is set up the way that it is. How, give priorities for me. I, we can’t, Rome wasn’t built in a day. I don’t think we can do all the things at once. Probably these people both work. How, what are the Big rocks that you would sort of put into the bucket first and then we’ll try to fill in around

Dr. Chris Pachel: Yeah, the first thing that I typically look at in cases like that is what would be the practical way to prevent those dogs from rehearsing those patterns. And what I mean by that is like, even if the owners are away at work and the dogs are exploding 15 times throughout the day, they are still rehearsing.

They are still practicing. They’re still going through the motions, getting that negative reinforcement. By, you know, effectively driving away all of those neighborhood intruders, so just going through the motions of doing it will continue to perpetuate the behavior. So all of that to say, what would it look like to manage that problem?

Not because management. automatically fixes it, but what would it look like? And so if I was working with this client, I may say, okay, rather than allowing the dogs off leash in the front yard, could we do off leash in the backyard, but leashes in the front rather than giving access to those front windows, especially when we’re not there to be able to offer any sort of training guidance for those dogs.

What would it look like to put up opaque window blinds, or is it possible to put up a baby gate across the door that allows them into the living room and give them comfy places to rest on the backside of the house where they can still find a sunbeam, they can still entertain themselves, but they’re not going to be triggered and react. So I’m looking for some of those easy wins right off the bat to say, you know what, you don’t love your dogs exploding 15 times an hour. I don’t either. And I’m worried that every time they do, it’s perpetuating this learning cycle for them. So let’s just kind of nip that in the bud as the case may be.

Let’s rather than going down the pathway of corrections and saying no, Why don’t we take them out of this situation at least temporarily? And let’s start onboarding some skills. What do we want them to do or how do we want them to feel when those triggers happen? Let’s avoid it when we’re not training, let’s train those foundations.

And then we can progressively make it more and more challenging until we’re able to reintroduce them to the windows, to the front yard. And for some of our dogs that we’re working with here, you know, some dogs can make that much progress in a weekend. Other times it takes a lifetime, you know, and they never quite know, depending on how that’s all going to come together.

But allowing them to continue practicing despite what you’re trying to do from, a training standpoint, it’s not gonna give you the results you’re looking for.

Dr. Andy Roark: Yeah. No, I love this. I’m, you’re, saying things to me that in retrospect seems so obvious and just one of the things I’m always amazed of in behavior is how rarely people think about just removing their pets from the situation. And I don’t know why that comes so slowly. To us, but now that you say this, I’m like, well, of course the solution is we’ve got to, we’ve got to, we’ve got to turn the, volume down here.

Like just continuing to let them look out the windows and do these things that just, it doesn’t make sense. And everything will get easier if we can just cut off 75 percent of the stimulus behavior. That, that, all makes sense.

Dr. Chris Pachel: so many people say in that moment who it’s like, no, but, my tongue really loves that. They really love.

Oh, they do love it!

Dr. Chris Pachel: It’s their entertainment. I’m like, you know what, I love some things that are probably not the best for thing for me to be doing too. so if the goal behavior change, we probably need to, you know, figure something out

Dr. Andy Roark: That. That makes sense. I, like to run after cars as well. It’s a super exciting thing, but my wife has

ended 

Dr. Chris Pachel: activity. 

Dr. Andy Roark: Exactly, right. The kids just, nobody wants to be around me when I do it. So, anyway, that totally makes sense. But you are right, it is. I think you’re, I think you’re I think you put your finger right on the human element where it sounds ridiculous where people get so frustrated, but they also recognize their dog loves this.

And so it’s like, well, I hate it, but boy, it gives him joy when he barks his head off and jumps over the fence.

Dr. Chris Pachel: Well, and for a lot of people, too, especially with a youngster who comes into the household, they may say, well, if he’s charging around the front yard or in the living room 15 times a day, I don’t have to walk him. I don’t have to do those other things. And so it kind of actually scratches an itch that a lot of owners have too.

And it’s not until we put those pieces back together and say, Hey, wait a minute. I’m not sure that your dog loves this particular activity as much as perhaps they might really enjoy. I don’t know, not being frantic or flying out into traffic and potentially causing some injuries to themselves or others in the process of doing all that they do.

So I think we can probably do better.

Dr. Andy Roark: yeah, I think you’re spot on. I think there’s also the conversation about the damage to the relationship and go, well, he loves it. But how do you feel about this? And do you think you have the healthiest relationship or a relationship that you, could your relationship be better if you did not have these problematic behaviors once an hour?

I think that all makes sense

Dr. Chris Pachel: I love that piece with it within it. Oh, sorry within that relationship piece. I wanted to see that one little detail there too, because. What oftentimes owners do when they’re experiencing frustration in those moments, and you may hear the dogs explode, and then the people explode right after them. And, you know, it almost becomes this sort of dance routine where there’s a trigger, a reaction, and then the, you know, the yelling or the intended reprimand.

And the thing that I get a little bit concerned about when we’re talking about relationships, and even. If I could go all the way to the point of a welfare concern for some animals is that if we have something that an owner is doing, and whether this is verbally reprimanding or giving a leash correction or using any sort of aversive, if they’re going down that pathway, but if the timing or the consistency isn’t spot on for that animal to actually change their behavior, ultimately, the takeaway is the animal is experiencing unpleasant situations.

In an unpredictable, uncontrollable way. And that’s actually a recipe for situational or generalized anxiety. And so I actually worry that in addition to a relationship breakdown, we actually increase the likelihood that animals who are experiencing some of those frustrated reprimands. Are actually going to have other issues that emerge because of the unpredictability or the aversiveness of the environment They’re living in and that’s not what anybody’s looking for their dogs So we can try some other strategies

Dr. Andy Roark: So, so, are you saying, Chris, that, okay, in this scenario, we’ve got the, so we’ve got the two dogs and they’re in the front yard and they’re just absolutely going nuts and the owner of the dogs comes out the front door and she’s like, hey, and she’s clapping, you know, and she’s doing exactly what you expect to try to get them to calm down, which of course is not working, has never worked, there’s nothing about the history of these dogs should indicate that this is going to be a successful strategy.

Yeah, every morning, we’re doing it. So she’s out there, and she’s grabbing the dogs by the collar. And again, I’m not trying to paint this person a bad light at all. I’m just This is hypothetical. It’s generally a picture of kind of what happens. I think everybody’s seen this exact scenario. So she’s coming out, and she’s grabbing the dogs, and she’s kind of yanking them back into the house.

Are you saying that because these dogs are out and they’re in a hyper aroused state and then Sometimes the owner shows up and sometimes she doesn’t because sometimes she’s not there or she’s in another part So sometimes she busts out the door and sometimes she doesn’t and sometimes she grabs them by the collar and sometimes she doesn’t that I’m more likely to see possibly generalized anxiety in these dogs because they’re having Situations like that.

Is that what you’re saying?

Dr. Chris Pachel: that is what i’m saying That’s exactly what i’m saying andy and it’s something that’s that I think is really misunderstood by a lot of owners And especially if I were working with that particular owner and if I was really trying to tease this out A response that I get very often is an owner who says, Oh, but I only do those things when the quote unquote bad behavior is happening.

So I am being super consistent about what I’m doing. I’m only squirting the cat with a squirt bottle. I’m only grabbing for the collar when that particular behavior is happening. And in those scenarios, I usually try to flip the conversation a little bit and say, Okay, I love the fact that you’re being mindful.

Of when you do that particular thing as an intervention if I were to ask your dog Whether you do that thing each and every time the behavior occurs How do you think they would answer me?

Dr. Andy Roark: That’s great.

Dr. Chris Pachel: Because that’s the learner’s perspective. That’s ultimately the one that matters It’s not whether I think i’m justified in punishing or reprimand.

It’s Does the animal have a clear correlation between a behavior that I do and a consequence that’s positive or negative? If I can’t make a one to one connection between those things, it is inherently unpredictable to me as the learner. And it’s the unpredictability that leads to confusion. And if the outcome is something that causes pain or distress or any sort of emotional conflict, now it’s something that is unpredictable.

And unpleasant. And that’s where anxiety comes from.

Dr. Andy Roark: Yeah. All right. I love that. You know, you are so great at validating pet owners when you’re talking to them. It’s just something you do so well. And I love, the way you phrase that and you flip that sort of question over. I think you make the point of what is consistent. I think you make it really clearly.

I also really love this, conversation because you’re, sort of validating one of the beliefs I’ve sort of acquired in my life and practice. When I was a young doctor, I had this idea that sometimes chaos happens, like rodeos sort of happen sometimes, and as I’ve gotten older, I have come to believe again and again, if you ever find yourself in a rodeo, meaning a chaotic situation you need to stop.

You need to stop and you need to step back and you need to get your people out of there because somebody’s gonna get bit, but you need to stop and you step back and we need to look at this and say, wait a second now, what’s going on here? and this in the, exam room, this sometimes is this is a overly stimulated patient.

This is an anxious, this is a afraid patient. And we just have back. Or, maybe working with an inexperienced assistant, maybe our, handling skills are not where they need to be. It should not have this chaos, and, I’ve just, I, it’s not even a conscious thought, but I feel chaos, and I go, this is, what are we doing here guys?

Let’s step back. And so, when I see this front yard scenario, and the dogs are barking, and one of them’s trying to jump over the fence, and the neighbor’s running out, and she’s yelling, I get that same feeling of, This chaos can’t be good. It just it can’t be good and you have validated that is as what you said everything fits with that of We’ve got to turn the volume down on this.

We have got to let’s step away from this Let’s get let’s get some baby gates in place Let’s just reduce and let’s start to work through this. Oh, man. This has been such a great conversation chris I really appreciate you being here Where can people find you online? Where can they learn more?

Where could they hear about your speaking engagements? Things like that. I’m sure people are gonna want to learn more from you. I do.

Dr. Chris Pachel: I love that, Andy. So the easiest place to find what I’m up to and what I put out there for, consumption, so to speak, is on the website, drPachel. com. So www. drpachel. com. And that’s where any podcasts like this one, or webinars that I’ve recorded, or articles that I’ve written, all of those get linked to the media pages there.

You can also find what we’ve been up to at the Animal Behavior Clinic or through Instinct Dog Behavior and Training, which I’m also a co owner of. So we’ve got all of these different ways. All of it’s all of it’s curated right through that website. So it’s a one stop shop. That’s where you want to go.

Dr. Andy Roark: That’s great. I’ll put a link in the show notes down to the website. Thanks so much for being here, Chris. Thanks for listening to everybody. Take care of yourselves.

​Dr. Andy Roark: And that’s it. That’s what I got for you guys. I hope you enjoyed this. I did. This is a real fun one I love it. I have pages of notes from my conversation with Chris. Anyway, thanks to him for being here Thanks to you for being here Take care of yourselves everybody. I’ll talk to you later on. Bye.

Non-Anesthetic Dentistry Fallout (HDYTT)

by

Dr. Amy Thomson joins us to explore non-anesthetic dentistry and client communication, tackling common fears about anesthesia and the importance of clear language in veterinary care. Learn from her expertise as she and Dr. Andy Roark discuss how to effectively manage cases like Nico, a Chihuahua with good teeth but bad breath on this week’s episode of the Cone of Shame Veterinary Podcast. Don’t miss these crucial insights that could transform your approach and elevate your practice. Let’s get started, gang!

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

American Veterinary Dental College: https://avdc.org/

Veterinary Dental Forum: https://www.veterinarydentalforum.org/

Amy Thomson IG: https://www.instagram.com/toothy.thomson/

Referenced Obi Vet Course: https://obivet.com/product-category/certificates/

VetHive:https://www.vethive.com

Amy Thomson website: https://toothythomson.ca

ABOUT OUR GUEST

Dr. Amy Thomson, often known as “Toothy,” is passionate about teeth! However, it was not always this way—she started her career in small animal practice with very minimal dentistry knowledge. She was fortunate to have a great mentor in her first job, where she learned a lot and her desire to learn more grew. Once she attended her first Veterinary Dental Forum in 2013, she KNEW dentistry was her passion—and became affectionately known as “Toothy Thomson.”

With time and support from her family, friends, colleagues, and a big ‘shove’ from her mentor, she applied for a dentistry and oral surgery residency and was overjoyed when she matched at the University of Wisconsin-Madison. During her residency, her passion grew not only for dentistry but also for teaching. And because life is always full of surprises, Dr. Thomson found herself at a crossroads in 2020 in the early stages of the pandemic—so she started her own mobile dentistry practice!

In addition to working alongside small animal general practice teams, she also became very active online, sharing her knowledge. It has always been important for her to share as much as she can, given it took hundreds of hours and thousands of dollars to obtain the knowledge she did while in general practice. Knowledge she wants to see all veterinary teams have!

EPISODE TRANSCRIPT

Dr. Andy Roark: Welcome everybody to the Cone of Shame veterinary podcast. I am your host Dr. Andy Roark. Guys, I got it going for you today. I have got my friend Dr. Amy Thomson on. She is a boarded veterinary dentist. I am talking to her about a weird case of a little chihuahua whose teeth don’t look bad, but his breath is nasty.

He’s got gingivitis. Yep, we’re going to talk about some non anesthetic dentistry today and how we talk to pet owners about it. And also how do we deal with it when you’ve got this pet that’s got some nasty stuff lurking under the surface, but the teeth look good and the owners think that they’re that they’re golden.

Anyway, it’s a good case. Let’s get into it.

Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark. 

Dr. Andy Roark: Welcome to the podcast, Dr. Amy Thomson. Thanks for being here.

Dr. Amy Thomson: Thanks for having me. I’m super excited to be here.

Dr. Andy Roark: It’s my pleasure. I, I’m so excited to have you here. For those who don’t know you, you are a boarded veterinary dentist. You and I met at the OVMA Convention in Ontario and you were speaking after me and we just started talking and I just I love your energy so much and like your passion for what you do just radiates through and so I really I wanted to spend more time with you and sort of talk with you and so I’m glad we were able to set this up.

Dr. Amy Thomson: It’s so, it’s so wonderful finding and getting to meet you in person and yeah, it was a, it was a great conference. I was super excited to be asked to be a part of it and then yeah, getting to connect with you and talk about teeth, which is my favorite thing to do. It’s pretty great.

Dr. Andy Roark: Yeah, see it’s I, I’ve got, I’ve got a tooth problem for you, actually, I want to, I want to bring up. So, I am looking at a five year old male neutered chihuahua named Nico. And so, Nico, Nico’s teeth, when I just looked in his mouth looked okay. But his breath stinks, and he’s got some gingivitis. And so, I started asking the owners about this, like, his breath, and what do you do for his dental health?

And they said, well, we’re very conscientious. Twice a year they do– they call it cosmetic dentistry. It’s anesthesia free dentistry and it sounds like they’ve been getting this service done for them. And now I’m, I’ve got Nico here and I’m, I’m looking at this dog and his, he’s got gingivitis and he’s got bad breath and I’m worried.

I’m going to, I’m going to, they’re going to let me do this. I’m really worried that it’s going to be a disaster when I get in there. And I’m hoping that you’ll talk, talk, you’d totally- don’t with me. Tell me I’m not, tell me I’m wrong. You’re supposed to “no it’s going to be fine.” 

Dr. Amy Thomson: No, I think you’re right. I’m worried. I’m worried about Nico’s now, for sure.

Dr. Andy Roark: So, so, tell, how do you treat this, Amy? Talk, talk me through this a little bit, like, where’s your head at when I bring you this case, and just sort of, start at a high level and let’s get down to kind of how I approach this, and, and how do I set expectations with the owners so I don’t get in a lot of trouble if I do come back to them with something they’re really not going to want to hear?

Dr. Amy Thomson: Yeah, yeah. So yeah, so this is always a challenging case and so I guess like taking it sort of back I think it’s really important to like meet these owners where they’re at. So they really care about oral health, which makes me happy And so I always try and start with acknowledging that. That like I’m very glad that you’re taking Nico’s oral health seriously and, you know, being proactive and having these anesthesia free cleanings done

obviously shows that, you know, you care and that you’re wanting to keep his mouth healthy. Unfortunately, this is not a great way to do it. And I’ll, and honest We, I’ve had this conversation and owners are like, what? Like we thought this was the right thing and all I’ll validate them and say, absolutely.

Like if I were in your shoes, based on the information that I see on the internet these seem great. It’s, they seem great because you see the before and after pictures and there’s all this calculus and then it’s all gone. The concern or the issue is unlike you and I that will sit still. Our pets rarely sit still and certainly not in a way that will allow us to do a deep clean underneath the gums and so Bringing it back to what I’m seeing in Nico’s mouth is despite the teeth looking quite clean I’m getting this smell and I’m seeing the gums are inflamed and those are my What I call my red flags when I look in the mouth to say that there’s there’s problems underneath The surface.

And so that bad breath or, you know, I sometimes joke about we like fancy doctor terms or halitosis. That’s actually volatile sulfur compounds and that’s the breakdown of tissue. That we’re smelling. So that sort of not like smells like canned dog food or whatever. We fed them, but that sort of unmistakable foul odor or halitosis is evidence that there’s disease and then the fact that his gums are diseased or at least inflamed says we’ve got inflammation there and so I can’t say I’m entirely surprised because if he’s been getting cleanings on the surface that we can see, but not deep under the gum.

There could be, you know, significant disease that we’re just not able to see when he’s awake.

Dr. Andy Roark: Do you tell pet owners that smell, that distinctive smell, is the breakdown of tissue? Do you tell them that?

Dr. Amy Thomson: Sometimes.

Dr. Andy Roark: That’s pretty intense. Like I, you kind of like, you’re kind of grossing me out like I’m–

Dr. Amy Thomson: I know it’s gross, but, but I also think it’s important I don’t see it as much anymore, but there used to be that like I haven’t been in general practice for a long time. It’s been eight, nine years. So I’m a little bit removed now, but I do remember when I was in and I would hear like, Oh yeah, they’ve got a little bit of doggy breath.

And, and I just think like we talked about when we met, it was like, I’m a big stickler for language and nomenclature and I don’t know, doggy breath sounds cute, but like what we’re smelling is, is evidence of disease. So, it a bit depends on the conversation I’m having with the owner, but I will acknowledge that like that smell that we’re smelling is indicating that there’s deeper disease going on.

Mm hmm.

Dr. Andy Roark: You, you are a stickler for language. Talk to me real quick, we’re just gonna take a little, a little side tangent here. You don’t like, you don’t like the term dental disease. You like the term periodontal disease.

Dr. Amy Thomson: I don’t

Dr. Andy Roark: Tell, tell me why that is. I, because I, like, I always say like, ’cause I, I feel like the pet owners get it when I say dental disease, but put push back on it.

Tell me, help me, help me understand.

Dr. Amy Thomson: I’m happy to So I recently put together a lecture for the veterinary dental forum called dentistry dirty words And so that’s top of the like one of the top of the list of the the words that I think are bad dirty words we should stop using and the reason being is that for me if I’m trying to like Understand communicating with owners if I say it’s dental disease, that means there’s a problem with the tooth And you, hopefully you, well maybe not hopefully, but I’ve heard this a lot and I get a lot of nods when I lecture of like who here has heard, you’ve made a recommendation, the teeth are quite bad, we need to get in and clean and probably extract, and then maybe we get a call back from the owner and be like don’t worry doc, the tooth fell out, we’re all good.

Dr. Andy Roark: Yeah, sure.

Dr. Amy Thomson: Yeah, so when we call it dental disease, it’s not, I don’t think it’s unrealistic for the owner to say, Oh, the tooth is a problem. The tooth is gone. The problem’s gone. Um, And so I do think using the appropriate term of periodontal disease and discussing that it’s the root surface of the tooth, but it’s also the gum, the bone and the ligament that are diseased to help understand why it’s so important to do the exam under anesthesia, to do the x rays, and then to make sure that we remove the tooth debride that area and close it up.

I do find, personally, I get more reception from owners of understanding the importance of say x rays or doing this under anesthesia kind of thing

Dr. Andy Roark: Do you think that fear of anesthesia is the number one reason that we tend to see these cosmetic dentistries coming in where the tooth root below the gingival line has not been taken care of? Is that, is that, is that, in your opinion, is that what really drives it?

Dr. Amy Thomson: Absolutely that’s been my experience both when I was a general practitioner now as a dentist oral surgeon taking referrals, and then I do a lot of like online education. And so you have to be careful with things online, like social media. There’s lots of people that will kind of chime in. And yeah, there is a, there is a huge fear of anesthesia.

And I think being fearful of anesthesia is, you know, important. I don’t, I’m not, I’m not here to say we shouldn’t be worried. I mean, I, I, I tell all of my owners, anesthesia is not a benign treatment. So there is always going to be a risk, albeit for most healthy patients, it’s, you know, less than 1%. And those that have comorbidities there’s lots of things that we can do as far as working up heart disease, kidney disease to make it as safe as possible.

And then we have. The wonderful people who are board certified anesthesiologists who can manage the higher risk anesthesia. So, I would say at least half, if not two thirds of my patients have kidney disease, heart disease, or sometimes both, yeah, but, but it is, owners are afraid, and I think that fear, I don’t think anyone’s doing it on purpose, but it’s almost like this fear mongering of like, you want clean teeth, which we talk about the importance of oral health, but you don’t want your pet to die, so here’s the solution.

The problem is that while we’re avoiding anesthesia, we’re not actually treating disease in their oral cavity and potentially we’re making it worse because the teeth look clean and so we’re not clued into the fact that actually below the gum line there’s problems.

Dr. Andy Roark: Hey guys, do you wish that your team was better at handling conflict management? Are you a leader, a medical director, a practice manager, a practice owner and associate vet that wants to not only be able to handle conflict really well in your team, but also to have the tools to train your people so that they have these conversations more gracefully with each other. 

Would you like to work at a place where we’re. We’re not sniping at each other. We’re getting along and communicating effectively. Guys, we can make that happen for you. I and the uncharted team will be at the hive event in Minneapolis is June 15th and 16th. We are having one day. Conflict management training program. 

So it will be, my team will be there is through uncharted. And so it is going to be one day of working with me and Stephanie Goss and Maria Pirita and we will be breaking down workshops on conflict management and you can drop in. You can get a day, you can spend the other day at the Hive conference. 

It is going to be an absolutely fantastic time, guys. Ah, I’m going to put a link in the show notes, head over there, check it out, grab your spot. This is not sit and be lectured at. This is round table workshop discussion format where you get your hands dirty. You get down to the weeds. We talk about what these tactics look like in our teams, in our practices. 

And we walk away at the end of the day with real skills to change the culture. In our practice guys, this is an investment in yourself is an investment in your team. It is an investment in your happiness and in your workplace. Do not miss the opportunity. It may not come around again. This is a great chance to work with us and to really stretch and expand your mind. 

And I promise you’re gonna have a great time, gang. Again, June 15th and 16th in Minneapolis. Hope to see you there. Let’s get back into this episode. 

Dr. Andy Roark: So, so, bringing this back to Nico. So, five years old seems young to me to have, especially, you know, when they’ve, they’ve, they have, they have been attentive in their way to his, to his oral health. I’m sort of surprised looking at this. Can you sort of lay down your approach to this case? So, I haven’t done any diagnostics here, but I’ve got Nico.

I’m trying to set expectations. How would, how would you approach this case from here? So walk me through kind of what your game plan would be, if you don’t mind.

Dr. Amy Thomson: Yeah, yeah, so again, I would acknowledge that, like, I think it’s great that they’re, like, taking an active approach and having his teeth cleaned. The concern is, is that despite the teeth looking clean and being free of plaque and calculus, there’s that, you know, bad breath, disease, I call it disease breath instead of doggy breath.

I don’t always maybe get as graphic as that.

Dr. Andy Roark: Yeah, exactly. Yeah 

Dr. Amy Thomson: and, and the fact that his gums either look a little bit darker pink or red, maybe a bit swollen. Definitely those are my two indications that there’s a deeper disease going on. And so the bet, I would explain to the owner, the only way to know the extent of this disease, unfortunately, is to do a tooth by tooth exam, just like our dentist does in our mouth, and take those x rays.

And then I’ll often joke around like, I wish we could do that awake, and he would just sit and go, ah, but unfortunately that’s going to require anesthesia. So I’d really like to get him scheduled in so we can get to the bottom of this, you know, bad breath, diseased breath, inflamed gums and figure out if this is, you know, hopefully we’re at a point where we’ve got a lot of buildup underneath the gum tissue that needs to be cleaned, but we don’t have significant bone or ligament loss or loss of those periodontal tissue structures where a deep cleaning is enough.

However, given his age and his size and potentially, you know, the smell or, or what you’re seeing we may find that, unfortunately, despite on the surface being clean, there’s been debris and disease underneath, and, and he may actually require extractions, but the only way to know for sure is to get those diagnostics, which, which will require anesthesia.

Dr. Andy Roark: Gotcha. Okay. Do you have any concerns about whenever I have these small dogs and I’m working in their mouth and I’m concerned about sort of significant, periodontal disease, things like that do you have any concerns about tooth extraction in tiny dogs, things like that? I mean, just if, if this has been going on and we’ve got significant dental disease when we get in there, I’m, I’m worried about breaking these little dogs, you know what I mean?

Like, like I’ve, I’ve seen these little jaw bones that have been sort of deteriorated. I’ve, I’ve seen them just snap and

Dr. Amy Thomson: Yeah. And they’re just like, they’re so little.

Dr. Andy Roark: So little and I don’t know. Is that fear completely un I can’t be, no it’s not completely unfounded, but like, is there, is there anything that I should be particularly aware of or anything that you can do to help me kind of protect myself if I do get in there and I find that the, there’s just been terrible deterioration of, of, of the jawbone, things like that.

Any tips or tricks for me? 

Dr. Amy Thomson: Not to get all nerdy, but there is publications to say that as our we bred dogs to get smaller and smaller, they don’t proportionally have smaller teeth. So smaller dogs actually have more of the volume in their jaw taken up by teeth. So that can create an issue when you have like a relatively big tooth.

I used to joke my little chichi, raisin nose. I used to joke. She was like the mask with the really big teeth, like the small little job, big teeth. And so it’s, it’s pretty common. So then if you imagine you have this really big tooth in this small jaw and then you start removing jaw, when you start to remove these teeth, you’re putting a fair amount of torque on the jaw to get this big tooth out.

And so, I think, And I will always say I said it a lot over OVMA is it’s important for you to be comfortable. So if you get into a mouth and you go this is way worse than what I thought Above all else do no harm like we take our oath is just let the owners know, you know, this is worse than what? We had thought and i’m concerned with the amount of bone loss and you know, the size of Nico. But there could be a risk that I could do some damage to his jaw.

And I just think it would be better in the hands of a colleague or, you know, perhaps we’ll do part of the work, but then come back because of course, depending on your clinic you may be scheduled for surgery and then in appointments. And the last thing you want to do with tooth extraction is try and rush.

Cause then I find when people rush, they get nervous. They use a bit more force. We’re more at risk to having problems happen. So I would just give everyone permission to say it’s okay to say like I’m not comfortable with this because you want to do what’s best for this pet. And then my little tip for that is I’m a huge huge fan of something called horizontal elevation.

So I find those that that had like a dentistry program in vet school or have gone to courses, I do find there’s a lot of what we call vertical elevation. So if this is like the tooth root, we put the instrument in down along it and we rotate which is, which is great. And one, technique in my toolbox.

The, so that’s vertical. It’s along the long axis. But horizontal, I find helpful in say like these big molars and these small dogs with the small jaw is if you actually say these are your two roots or two crown root segments, I put my winged elevator in between so perpendicular. And then when I rotate, I’m stretching the tooth against tooth and I’m putting less torque on the jaw while I support that jaw. And so, less likely not impossible but less likely to cause iatrogenic jaw fracture to that jaw because you’re not putting a ton of torque on that small jaw that’s potentially diseased.

Dr. Andy Roark: No, that totally makes sense. Okay, I feel like I got a plan here. I think I know how to approach this. Any last words of advice for me? Anything that you, that you could foresee that I would want to avoid as far as a pitfall or make sure that I do well?

Dr. Amy Thomson: I think you have a good plan. I just think like open communication and just like knowing that, you know, It’s very common for owners to feel like these anesthesia free cleanings are in their dog’s best interest because they’re scared of anesthesia And they know how important oral health is and probably at most of their pets visit The vet is talking about the importance of oral health So I think just letting them know that like we know they were doing what they felt was best and unfortunately There’s just not enough of us being able to be the voice out there to say that that these anesthesia free pains, while they avoid anesthesia very much limit in what we can do.

We can’t do diagnostics. We can’t do true, you know, therapeutic treatment. And so just talk to them about, you know, we may find that we have to extract multiple teeth from Nico, but he’s going to be healthier. And then when he comes back, I always tell owners, once he comes back at two weeks, I always see all my patients at two weeks, make sure they’re healing.

Then let’s talk about things that are going to be really helpful that you can be doing. So that we don’t kind of get into this situation in the future. There’s always a tooth brushing discussion and demo. And then we’ll talk about, you know, setting expectations for COHATs, or Comprehensive Oral Health Assessment and Treatment which is the cleaning the x rays under anesthesia.

And, and talk to them about what is realistic for them to feel comfortable doing, both from an anesthetic standpoint, overall pet health, cost and just sort of work together to make a plan. And, and let them know, you know, I’ll have recommendations, but this, this needs to be a team effort for Nico.

Dr. Andy Roark: Yeah, that totally makes sense. Thank you so much for being here. Amy, do you have any favorite resources for anybody if people are like man, this is my jam I love I love I love dental health. I mean you’re this is your passion. What are your favorite..

Dr. Amy Thomson: I love it. 

Dr. Andy Roark: Resources? 

Dr. Amy Thomson: Yeah,so, the veterinary dental forum that sort of like that was like Christmas for me and is every year I’ve been I don’t know. I think it’s like 11 years in a row now I’ve been, I’ve gone, or I’m coming up on my 11th forum. Lost track. But I went there early on in my career and it’s such an amazing weekend.

So it’s three full days of lectures. It’s broken up between sort of, beginner, intermediate, advanced. There’s practice management series. There’s technician series. And then there’s a bunch of wet labs and it’s just like a whole bunch of tooth nerds that are just real excited to talk about teeth.

And you can just really be immersed in that. And I always find like, even now I will, I will still learn things when I go. And, and it was interesting because when I was lecturing there last, last year I was also a moderator and, and hearing other diplomates talk about things that I talk about, you’re like, oh, it’s interesting they use that instrument a little bit differently.

So, it’s just like a huge wealth of knowledge. So if you’re available and can go, it’s normally in the fall, it moves around the continental U.S. It’s in Palm Springs this year at the end of September. So a pretty nice locale location. And, It’s a ton of CE. Definitely love that.

And then the AVDC website or the American Veteran Dental College has a lot of resources for ongoing CE and things like that. Which is really helpful if you’re looking for more. That’s sort of where I started many, many years ago, getting my education.

Dr. Andy Roark: That’s awesome. Well, thanks so much for sharing that. I’ll put links on the show notes guys. Thanks for being here. Amy. Thanks for being here. Take care of yourselves everybody. Yeah

And that’s what I got for you guys thanks for tuning in. I hope you enjoyed it. I hope you got something out of it. Thanks to Amy for being here and sharing her pearls of wisdom. Yeah, I really appreciate everybody’s time. I appreciate your time and her time and Dustin’s time who produces our episodes. It’s like don’t forget Dustin.

And so anyway, everyone is appreciated in the making of this episode. Anyway, guys, I’ve had enough. It’s been a day. I’m going home. Take care of yourselves, everybody.